The public still loves the NHS. It’s a national institution and continues to top the list of things that make us most proud to be British (50%).
Why? It provides free care at the point of access (well, mostly), something we have that many others, like our American cousins, don’t. But it’s also because of our enduring reverence for the health professionals who staff our NHS.
From a public point of view, doctors still top the poll of who people trust (89% of us trust doctors to tell the truth; just 21% for politicians). The GP Patient Survey tells us that 92% of patients had trust and confidence in the GP they last saw, as did 84% for the last nurse they saw.
But this relationship between the public and our health professionals is under strain, as the NHS faces its gravest challenges yet.
In some respects, the public is only too aware of the financial issues the NHS faces; 84% think the NHS will face a severe funding problem in the future (up from 72% in 2008). Hospital bosses and GPs might question what planet the other 16% are on, but still, rarely does a question yield a result higher than that.
The public is also very understanding of the position that health professionals find themselves in. When we talk to patients qualitatively, they tell us about overstretched nurses rushing around all day. They overlook slight lapses in care because they think nurses are under too much pressure. Indeed, understaffing and a lack of doctors and nurses is spontaneously cited as the second biggest problem facing the NHS, after a lack of resources or investment.
This reflects the experiences of health professionals on the ground – between 2013 and 2015 there has been a 50% increase in the number of vacancies for nurses and 60% for doctors. Even beyond the NHS, a shortage of nursing staff is partly to blame for dwindling numbers of nursing home beds, exacerbating the problems the NHS is having with discharging patients.
In the face of these challenges, how far can the relationship between the public and health professionals stretch? It would appear it’s not unconditional on either side.
Take the recent junior doctors strikes as an example. A majority of the public still supports the strikes (57% at the time of the last strike in April). However, support was down from 66% in January (partly because emergency care was affected for the first time) and the blame is starting to shift. Although 54% still blame the government for the strikes, by April, one third of the public thought doctors and the government were equally to blame (35%, up from 18% in February).
How about from the health professionals’ point of view? Our qualitative research shows that GPs chose their profession partly because of the chance it offered to generate meaningful doctor-patient relationships and work in a community to improve lives.
But how does the reality live up to that? Those relationships are under pressure from workload – a workload generated to some extent by changing patient demand and the challenges of dealing with patients who have ever rising expectations. Despite widely-held fears of an NHS financial crisis, these expectations have not been dampened.
So we are heading into what may be the most challenging winter yet for the NHS. Based on past performance we have to assume that that it will be able to muddle through it. But how will relationships between the public and health professionals be affected by the end of it? If more junior doctor strikes go ahead, will the public increasingly see them as being to blame and run out of sympathy? Or will health professionals run out of patience with their demands first?
It’s unlikely. Health professionals care for us when we are at our most vulnerable, giving us a particular affection for them. And they are motivated by caring for their patients. Like an infatuated couple, health professionals and the public will keep making allowances for each other. The special relationship will endure.