the nhs at the heart of the election what do politicians have to say? jonathan nicholls head of...

The NHS at the heart of the electionWhat do politicians have to say?

Jonathan NichollsHead of Health Research, Ipsos MORI Public Affairs

Who’s going to be running the show?

Voting Intention: all giving an opinion vs. those “certain to vote”

38%

34%

11%

17% 40%

32%

16%

12%

How would you vote if there were a General Election tomorrow?

Base: All giving a voting intention = 777 unweighted, All certain to vote = 519 unweighted; data collected among 1,001 British adults 18+, 26th-28th January 2010

All giving a voting intention (78%)

All certain to vote (52%)

Con

LD

Lab

Other

ConLD

Lab

Other

Source: Ipsos MORI Political Monitor

Conservative lead = +4 Conservative lead = +8

0

10

20

30

40

50

Jan

-03

Ma

r-03

Ma

y-03

Jul-0

3S

ep

-03

No

v-03

Jan

-04

Ma

r-04

Ma

y-04

Jul-0

4S

ep

-04

No

v-04

Jan

-05

Ma

r-05

Ma

y-05

Jul-0

5S

ep

-05

No

v-05

Jan

-06

Ma

r-06

Ma

y-06

Jul-0

6S

ep

-06

No

v-06

Jan

-07

Ma

r-07

Ma

y-07

Jul-0

7S

ep

-07

No

v-07

Jan

-08

Ma

r-08

Ma

y-08

Jul-0

8S

ep

-08

No

v-08

Jan

-09

Ma

r-09

Ma

y-09

Jul-0

9S

ep

-09

No

v-09

Jan

-10

Voting Intentions Jan 03 – January 10 (all certain to vote)

Base: c. 1,000 British adults each month through June 2008; c. 500 British adults thereafter

40%

16%


Howard elected (Nov 03)

2005 General Election

Cameron elected (Dec 05)

Brown as PM (Jun 07)


32%

Which leader do you think … Gordon Brown, David Cameron or Nick Clegg?

25%

37%

28%

33%

43%

34%

46%

33%

10%

9%

10%

15%

19%

10%

10%

4%

11%

10%

12%

10%

12%

8%

25%19%

27%

Comparing Leaders

…is more honest than most politicians

…best understands world problems?

…would be best in a crisis?

…is most out of touch with ordinary people?

…best understands the problems facing Britain?

Source: Ipsos MORI Political MonitorBase: 1,003 British adults 18+, 25th-27th September 2009

Don’t knowBrown Cameron NeitherClegg

-50

-40

-30

-20

-10

0

10

20

30

40

Ne

t sa

tisfie

d

HAGUE (1997-2001)

DUNCAN SMITH (2001-2003)

HOWARD (2003-2005)

Net satisfaction with Opposition Leaders (1994 – 2009)

Number of months from becoming leader

CAMERON (2005-?)

How satisfied or dissatisfied are you with the way … is doing his job as leader of the … Party?

BLAIR (1994-1997)

Base: c.1,000 British adults interviewed 3rd week of the month Source: Ipsos MORI Political MonitorNote: Data collected prior to May 2008 was collected via face-to-face methodology; data collected from June 2008 was via telephone

Note: methods change for Cameron; see below

So what does all this mean– good news for Lib Dems?

40

30

20

10

0

10

20

Jan2003

Jul2003

Jan2004

Jul2004

Jan2005

Jul2005

Jan2006

Jul2006

Jan2007

Jul2007

Jan2008

Jul2008

Jan2009

Jul2009

Jan2010

Con

serv

ativ

e le

adLa

bour

lead

General Election ’05 (Labour majority of 66 seats)

Est. Labour lead required for a Labour overallmajority

Est. Cons’ve lead required for a Cons’ve overallmajority

Base: c. 1,000 British adults each month Source: Ipsos MORI Political Monitor


What about views on the NHS?

67

18

0

10

20

30

40

50

60

70

2000

Spr

ing

2001

Wint

er

2002

Spr

ing

2002

Wint

er

2003

Spr

ing

2003

Wint

er

2004

Spr

ing

2004

Wint

er

2005

Spr

ing

2005

Wint

er

2006

Spr

ing

2006

Wint

er

Mar

ch 2

007

July

2007

Dec 2

007

Mar

ch 2

008

Jun-

08

Highest levels of satisfaction with the NHS

Q Overall, how satisfied or dissatisfied are you with the running of the National Health Service nowadays?

Base: English adults aged 16+ (c.1,000 per wave) Source: Ipsos MORI Perceptions of the NHS Tracker

% SatisfiedSatisfied

Dissatisfied

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

% satisfied

Base: English adults age 16+ (c.1,000 per wave) Source: Ipsos MORI Perceptions of the NHS Tracker

Outpatients 86%

A&E 74%

GPs 91%

Inpatients 85%

NHS overall 67%

* Small base size means comparison of figures and trends is indicative only

General upward trend in satisfaction…

Even if doubts about national standards, local NHS seen as good

Q To what extent, if at all, do you agree or disagree with the following statements?

% Agree

26

52

74

0

10

20

30

40

50

60

70

80

Winter2003

Spring2004

Winter2004

Spring2005

Winter2005

Spring2006

Winter2006

March2007

Dec 2007

March2008

Jun-08

The government has the right policies for the NHS

The NHS is providing a good service nationally

My local NHS is providing me with a good service

Base: English adults aged 16+ (c. 1,000 per wave) Source: Ipsos MORI Perceptions of the NHS Tracker

Base: NHS satisfaction – c. 1,000 English adults aged 16+ interviewed face-to-face per wave, Government satisfaction – c. 1,000 GB adults aged 18+ interviewed by telephone per wave (N.B interviewed face-to-face until June 2008)

Source: Ipsos MORI/DH Public Perceptions of the NHS Tracker, Ipsos MORI Political Monitor

% Satisfied with current running of NHS

% Satisfied with way government is running the country

Since Autumn 2007 public attitudes towards the NHS appear to have moved away from more general opinions of government. This may suggest current high levels of satisfaction with the NHS reflect real improvements to its services.

Q Overall, how satisfied or dissatisfied are you with the running of the National Health Service nowadays?

Q Are you satisfied or dissatisfied with the way the Government is running the country?

Satisfaction with NHS less linked with attitudes towards government than in the past

73

25

0

10

20

30

40

50

60

70

May1997

May1998

May1999

May2000

May2001

May2002

May2003

May2004

May2005

May2006

May2007

May2008

May2009

NHS has fallen as an issue facing Britain

NHS

Crime/ Law & Order

Race/ immi-

gration

Economy

Source: Ipsos MORI Issues Index

What do you see as the most/other important issues facing Britain today?

Unemployment

Base: representative sample of c.1,000 British adults age 18+ each month, interviewed face-to-face in home

39%

20%

17%

15%

13%

10%

6%

6%

6%

6%

5%

5%

3%

Asylum/ immigration

Unemployment

Pensions

Afghanistan

Education

Party leader/policies

Managing the economy

Protecting the environment

Healthcare

Defence

Crime/ anti-soc. behaviour

Looking ahead of the next General Election, which, if any, of these issues do you think will be very important to you in helping you decide which party to vote for? Change from

August 2008*

-4

n/a

n/a

-4

-12

-8

-1

+10

-5

-2

+4

Key election issue: the economy stupid … but health also important

+2

Source: Ipsos MORI Political MonitorBase: 1,003 British adults 18+, 25th-27th September 2009NOTE: Trend is from a face-to-face, prompted question. This year’s question is asked open-ended.

Taxation

All at 3% and above

Europe 0

30%

22%

27%

22%

29%

25%

31%

24%

25%

27%

15%

20%

21%

12%

10%

15%

11%

10%

18%

9%

10%

29%

37%

23%

Managing the economy

Unemployment

Asylum/ immigration

Healthcare

Crime & anti-social behaviour

Education

Defence

Taxation

Which party has the best policies on … ?

Source: Ipsos MORI Political MonitorBase: 1,003 British adults 18+, 25th-27th September 2009

+5

-15

-2

-5

+14

+11

+3

+2

Conservative lead over Labour

Labour Conservatives Lib Dems

39

20

17

15

13

10

6

6

% who think issue is ‘very important’ in helping them decide how to vote

NB. Figures exclude ‘don’t know’, ‘none’ and ‘other’ responses

The elephant in the room….

92

94

96

98

100

102 1980 Q1 1990 Q3 2008 Q3

Green shoots?

Employment levels, rebased*

1 2 3 4 5 6 7 8

Recession starting in

*Quarter before start of recession = 100Source: ONS/Economist

Years since start of recession

!

Over the next three years…

The problem is that this isn’t registering….

-2

14

1

-7-12

-51

-4 -2

9

-11

-23

-32-27

-30

-14-19

-11-15

-8

-35

-25

-15

-5

5

15

Mar-02

May-02

Sep

-02D

ec-02M

ar-03Ju

n-03S

ep-03

Dec-03

Mar-04

Jun-04

Sep

-04N

ov-04Feb-05M

ay-05S

ep-05

Nov-05

Mar-06

May-06

Sep

-06N

ov-06M

ar-07M

ay-07S

ep-07

Nov-07

Mar-08

Sep

-08Ju

n-09N

ov-09

People apprehensive about NHS over next few years – but its not about financial crunch

Base: c.1,000 British Adults

% net better

Thinking about the NHS over the next few years do you expect it to get better/worse?

Source: Ipsos MORI

2005 General Election (May 05) – Hewitt replaces Reid

as Health Secretary

Cameron elected (Dec 05)

Brown as PM (Jun 07) – Johnson replaces Hewitt as

Health Secretary 1p rise in National Insurance for NHS (Apr 02)

Reid replaces Milburn as Health Secretary (Jun 03)

Burnham replaces Johnson as Health Secretary (Jun 09)

-80

-60

-40

-20

0

20

40

Jan

'97

Jun

'97

No

v '9

7

Ap

r '9

8

Se

p '9

8

Jan

'99

Jun

'99

No

v '9

9

Ap

r '0

0

Se

p '0

0

Fe

b '0

1

Jul '

01

De

c '0

1

Ma

y '0

2

Oct

'02

Ma

r '0

3

Au

g '0

3

Jan

'04

Jun

'04

Oct

'04

Ma

r '0

5

Au

g '0

5

Jan

'06

Jun

'06

No

v '0

6

Ap

r '0

7

Se

p '0

7

Fe

b '0

8

Jul '

08

De

c '0

8

Ma

y '0

9

Oct

'09

Index (get better minus get worse)

The Ipsos MORI Economic Optimism Index

Base: c. 1,000 British adults each month

+28

-46

-4 -4

-56


Do you think that the general economic condition of the country will improve, stay the same or get worse over the next 12 months?

+20+23

38

18

41

22

8

22

5

29

A denial of seriousness of national debt…

% Tend to disagree % Strongly disagree% Tend to agree% Strongly agree

There is a real need to cut spending on public services in order to pay off the very high national debt we now have

Making public services more efficient can save enough money to help cut government spending, without damaging services the public receive

Base: 1,004 British adults, 19-21 June 2009

Source: Ipsos MORI Public Spending Index

40%

To what extent do you agree or disagree with each of the following statements about public services in Britain?

75

24

9

50

3 months later, even fewer want to look at cuts

To what extent do you agree or disagree with each of the following statements about public services in Britain?

There is a real need to cut spending on public services in order to pay off the very high national debt we now have

Making public services more efficient can save enough money to help cut government spending, without damaging services the public receive

Base: 1,041 online British adults aged 16-64, 4-7 Sept 2009

% Disagree% Agree

1

1

10

8

33

57

40

40

21

50

19

10

Perhaps because most people don’t feel personally squeezed

Base: 984 British adults, 15th May – 21st May 2009

Your personal finances

The economy in your local area

The British economy

% Very good % Fairly good % Fairly poor % Very poor

How would you describe the current state of…

Source: Ipsos MORI

Why is this a problem for the NHS?

Consistent view it should be protected

7372

73

2527

23

0

10

20

30

40

50

60

70

80

90

2000

2001

Spring

200

2

Wint

er 2

002

Spring

200

3

Wint

er 2

003

Spring

200

4

Wint

er 2

004

Spring

200

5

Wint

er 2

005

Spring

200

6

Wint

er 2

006

2007

1st

Qtr

All ABC1 C2DE

% Q10 Which of the following statements best reflects your thinking about the NHS?

Base: English adults age 16+ (c.1,000 per wave)

The NHS is crucial to British society and we must do everything to maintain it

The NHS was a great project but we probably can’t maintain it in its current form

31%

41%

28%The NHS should provide all drugs and treatments no matter what they cost

Base: British public, 18+ (1,001) 12-17 January 2006

The NHS should provide the most effective drugs and treatments no matter what they cost

The NHS should provide the most effective drugs and treatments provided they represent good value for money

72% expect NHS to provide drugs no

matter what they cost

no matter what they cost

treatments no matter what they cost

It will provide me with everything I need … = no limits on spending

82

687373

2722

24

1814

9

171213

7774

6361

57

% Agree % Disagree

June 08

Base: English adults aged 16+ (c. 900 per wave) N.B arrows represent significant differences in agreement from June-Aug 08

The NHS will be there for me when I need it

Britain’s National Health Service is one of the best in the world

Q Please tell me whether on the whole you agree or disagree with each of the following statements?

July 08

August 08

June 08

July 08

August 08

June 08

July 08

August 08

Source: Ipsos MORI NHS 60th awareness tracking August 2008

My local NHS helps improve the health and wellbeing of me and my family

The psychological contract

82%

58%

46%

35%

15%

13%

8%

6%

1%

*%

5%

… and public want NHS protected

The NHS/health care Schools

The Police

Defence

Local authority servicesBenefit payments

Social services

Care for the elderly

Overseas aid

Which TWO or THREE, if any, of the following main areas of public spending do you think should be protected from any cuts?

None of theseDon’t know

Base: All who think some services should be protected (773), 19-21 June 2009 Source: Ipsos MORI Public Spending Index

As well as funding challenges….- we're older and we're more expensive to treat- we expect services to give us what we want- we're all expert in what's wrong with us and what the NHS should be doing about it- we expect it of right and we're more vocal in demanding it- and we don't trust you if you say we can't have it

Which means...

We have a much stronger sense of being denied (by the NHS)

Huge expectations pose real challenge to the NHS…

Unrealistic public expectations likely to do reputational damage to NHS – and undermine public

support

Which brings with it real risks…

The sentimentality we attach to the NHS will disappear as a new generation realises the financial implications. The IPOD (Insecure, Pressurised, Overtaxed and Debt-ridden) Generation, now in their thirties, will simply rebel by voting out politicians who want to maintain the current system

Prof Karol Sikora, Sunday Times, 31 August 2008

A backlash?Early signals….

85%

55%

Becoming a less compassionate society?

Source: British Social Attitudes Survey 2010

The state has a duty to provide a decent standard of living for the unemployed

1985 Now

51%

38%

Government should redistribute wealth to help the poor

1994 Now

01020304050607080

April '97 November '00 April '05 June '09

%

Fewer now support extending services

Tax cut/reduce servicesThings left as are

Don’t know

Tax increase/extend services

People have different views about whether it is more important to reduce taxes or keep up government spending. How about you? Which of these statements comes closest to your own view?

Source: Ipsos MORI Base: c.1,000 British Adults

% Taxes should be cut, even if it means some reduction in government services, such as health, education and welfare

% Don't know

% Things should be left as they are

% Government services such as health, education and welfare should be extended, even if it means some increases in taxes

46%

33%

18%

2%

So what do politicians have to say?

An ageing society, technological advances and public expectations are placing demands that all countries are struggling to meet. Countries do not have infinite sums of money to spend on health. … The debate is not about whether - but how - healthcare budgets can be most fairly shared out among a country's citizenry.

Sir Michael Rawlins, Chairman of NICE, 18 August 2008

A debate is needed…

As a society we have to make some hard choices for the NHS

- what it should deliver, what it shouldn’t- how it decides what’s “fair”- should NHS rewards personal responsibility?

This is about determining a new psychological contract between public, clinicians and the NHS about what the NHS can and can’t do…

Need to lead a fundamental debate with the public and clinicians…

the nhs at the heart of the election what do politicians have to say? jonathan nicholls head of...

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