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01 April 2021

Misperceptions about NHS risk undermining views of its sustainability

The public tend to think the health service is performing less well than it is in reality

emergency dept

The NHS and public health: perceptions vs reality

Read the research

Research carried out by the Policy Institute at King’s College London and supported by the Health Foundation has found the public have a strong understanding of some aspects of the NHS – but on others they have significant misperceptions, which risk undermining how sustainable the health service is seen to be.

The research is based on a survey of 2,056 people in England during the second national lockdown in England (26 November to 1 December 2020). The survey focused on public perceptions of the NHS in normal times, outside of the pandemic. The findings reveal the public tend to think the NHS is performing less well than it is:

  • The public think that 52% of people had to wait longer than 18 weeks for routine hospital treatment in 2019 – three times the reality of 17%.
  • The public think 49% of all attendees at Emergency Departments take longer than four hours from arrival to admission, transfer or discharge – twice the actual level of 24%.
  • The public believe 36% of NHS nursing positions in England were vacant in December 2019, when 11% were in fact empty.
  • Between 2010/11 and 2016/17, there was a 1% increase in the number of nurses in England – but the most commonly chosen answer, selected by nearly a third of the public (31%), is that nursing numbers declined by 10%.

The public also had inaccurate perceptions about several other important issues for the health service:

  • They guess that 36% of NHS England spending was on private sector providers in 2018 and 2019 – five times the reality, which is 7%.
  • Respondents thought that 45% of NHS staff were born outside the UK in 2019, compared with the actual figure of 23%.

Misperceptions may undermine how sustainable the NHS is seen to be

These misperceptions may be influencing people’s views on threats to the NHS. For example, 70% of people think creeping privatisation is a fairly or very big problem for ensuring the NHS continues to exist in its current form. 77% also believe workforce shortages are a big problem and half the population either think the health service won’t exist in its current form in 2050 (31%) or say they don’t know if it will (25%).

And more generally, the public are extremely positive in their views of the NHS overall: 84% agree it is one of the best healthcare services in the world, and 86% rate the care they receive as good. This has only grown stronger following the pandemic, with 44% saying they’ve become more satisfied with the running of the NHS as a result of the Covid-19 crisis.

Misperceptions about the health of the nation

The public also have an inaccurate view of some aspects of the health of the nation, believing that certain trends are worse than they actually are: they guess that 39% of adults in England smoked in 2017 – more than double the real proportion, 17%. Even when told the proportion of adults that smoked in 2006, half of respondents still guessed that smoking had increased, pointing to a perception that the nation is getting less healthy.

But despite this, the public still mistakenly believe that life expectancy in the UK compares more favourably to other nations than it actually does. The public’s average guess is that the UK ranks 16th out of 35 OECD countries on this measure, when it actually came 23rd in 2019.

Where the public have a strong understanding of the reality

However, the English public do have an accurate understanding of some aspects of the health service. In 2019, 56% of NHS staff in England reported working additional unpaid hours each week, and the public have a very accurate perception of this workload, based on their average guess of 57%. There was also a 23% increase in NHS outputs between 2010/11 and 2016/17, and this is the most commonly guessed option, with a quarter of people in England correctly selecting it.

Professor Bobby Duffy, Director of the Policy Institute at King’s College London, said:

“Our misperceptions of reality are a key insight into our underlying worries – and it’s clear that many of us think things were worse in the NHS over the years before the pandemic than they actually were. Our ratings of our care are high, and our love for the NHS overall remains incredibly strong, but we still think it’s creaking more than it is, in missing waiting list targets and treatment times. And we think that the direction of travel is more of a threat than it really is – for example, in overestimating the scale of privatisation. These misperceptions are important to counter, as they may undermine our belief in the long-term sustainability of an institution many hold dear – a comprehensive, tax-funded service that is free at the point of use.”

Charles Tallack, Assistant Director for the Research and Economic Analysis for the Long Term (REAL) Centre at the Health Foundation said:

“The NHS is often referred to as unsustainable, with arguments tending to cite population ageing, the increasing prevalence of chronic conditions and ever more expensive treatments. However, while it is true that health spending has risen and will continue to do so, there is still a long way to go before we hit the limit of what we can spend. The UK’s total health spending is the second-lowest of the G7 countries, a group of the world’s largest developed economies. Understanding why and how our false perceptions have arisen is a first step to shifting them and part of the solution will be getting the relevant facts about health and the NHS into public debate. Countering misperceptions is not a straightforward challenge but it is vital to good decision-making and ultimately the future of our NHS.”

Technical details
Savanta ComRes surveyed 2,056 English adults online from 26 November–1 December. Final data were weighted to be demographically representative of English adults 18+ by age, gender, region, SEG and both 2019 and 2016 voting history. This period coincided with the second national lockdown in response to the Covid-19 pandemic, and this context undoubtedly influenced the responses.

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