In the run-up to the 2015 General Election, the Nuffield Trust regularly surveyed a panel of 100 health and social care leaders in England for their views on a range of issues, including finance, general practice and rationing.
The panel members are drawn from across the NHS and social care, with the majority working in hospitals, ambulance trusts, community services, general practice, local authorities, and private and voluntary sector providers. The patients’ perspective is provided by individuals working in local Healthwatch bodies.
The first survey was conducted in June 2014, the second in September 2014, the third in December 2014, and the fourth survey in March 2015. Further surveys have been undertaken but the tracker questions have been discontinued.
Each pre-election survey asked a number of ‘tracker’ questions, to assess whether there were shifts in the views of the health and social care leaders over time. The questions covered access to health and social care, any perceived changes in the quality of both health and social care, and the long-term viability of comprehensive, publicly funded health care.
Given the small sample size, caution should be exercised in the interpretation of changes over time; however, we are including the comparisons between surveys as a general indication of perceptions among the panel members. These findings are presented below.
Alongside the tracker questions, for each survey we ask a series of questions focused on a topical issue.
- 28% consider that quality of NHS care for patients has worsened over the last year
- 85% think that the quality of social care services has worsened in the last year
- 4 in 10 identified access to urgent care as the most concerning access challenge
- 57% believe the NHS will be free at point of use in 10 year’s time
Question one: Since this time last year, do you think the quality of health care that patients receive from the NHS has…
Yet again, a majority of panel members completing this fourth survey (72%) think that the quality of NHS health care has either improved or stayed the same. The proportion of respondents holding this view has increased by four percentage points compared with the previous survey.
Conversely, the number believing that the quality of health care has worsened decreased to 28%; however, this was 15 percentage points higher than when we first asked the panel in June 2014.
Comments made by panellists illustrate the pressure that NHS staff are experiencing:
The quality of health and social care is being sustained by the inherent professionalism of clinicians and care-givers rather than the development of improved clinical services or investmentCCG panel member
Throughout the health and social care system there are increasing signs of battle fatigue on the part of really hard-pressed staff struggling with inadequate capacity and compounded by intrusive monitoring and assurance demands from the centreCCG panel member
Question two: Since this time last year, do you think that the quality of social care that service users receive from local authorities has…
The picture for social care quality is bleaker than for health care. Eighty-five per cent of panellists answering the March survey think social care has got worse over the last year; an increase of seven percentage points on the previous survey and an increase of 29 percentage points since we first asked the panel in June 2014.
One respondent told us:
Social care is really in dire need – and feeling the impact of local authority spending cuts. It is often seen as the poor relation to that of NHS health care – yet it props up the health and social care system with carers that are largely on zero-hour contracts and minimum wagesHealthwatch panel member
Access to urgent care in my hospital is limited by four wards of patients awaiting discharge – some of this is for social careAcute trust panel member
Question three: At the present time, which issue concerns you most regarding access to health and social care services in your local area?
Access to urgent health care services was rated as most concerning by 37% of respondents, with access to social care being selected by 31% of respondents. These two areas continue to preoccupy health leaders, having now been identified as the most concerning for all four surveys.
Getting a GP appointment was selected as most important by a further 17% of respondents, followed by mental health services, with 11% choosing it as most important.
Question four: How likely do you think it is that comprehensive health care (excluding charges that already apply), will still be provided free at the point of use in England in ten years’ time?
In our December survey, 58% of panellists said they thought it likely that comprehensive health care would still be provided free at the point of use in England in ten years’ time. In March, the figure is 57%. This hints at a renewed optimism since we first asked the panel in June 2014, when just 47% said they thought it was ‘very’ or ‘quite’ likely that comprehensive health care would be provided free at the point of use ten years’ time.
Panellists’ comments suggested a degree of confidence in the sustainability of the political commitment to a service free at the point of use. One said:
I think there is a distinct change in the public mood towards support for the NHS which will help secure its futureAcute trust panel member
Care is unlikely to not be free at the point of access due to political imperatives, however costs will need to be contained and rationing appears likely in some form, overt or covertAmbulance trust panel member
Nuffield Trust (2014) Health leaders' panel: survey tracker. Nuffield Trust, 14 Nov 2014.