• Health and social care services are under extreme strain and improvements in life expectancy are stalling. As the new prime minister sets out her agenda for government, understanding what the public thinks should inform policy.
• This report examines public perceptions and expectations of health and social care in the UK in 2022 as the country learns to ‘live with COVID-19’. It highlights findings from the second survey in our programme of public perceptions research that tracks the public’s views on health and social care in the UK every 6 months.
• Our latest survey was conducted between 26 May and 1 June 2022. We surveyed 2,068 people aged 16 years and older in the UK using a random probability online panel – the gold standard in survey research.
• The public is pessimistic about the state of the NHS. The majority (55%) think the general standard of care has got worse in the past 12 months. Expectations for the next 12 months are slightly less pessimistic than 6 months ago: 39% think NHS standards will worsen, while 22% expect standards to improve. Less than half think the NHS is providing a good service nationally (43%) or locally (42%).
• Just 13% think their government has the right policies for the NHS. But the public points to priorities for future policy: reducing waiting times for routine hospital treatment and expanding and supporting the workforce are their top priorities for the NHS. The public supports a mix of measures to fix NHS staffing issues, even if they mean extra public spending.
• The public is also pessimistic about adult social care. The majority (56%) think standards have got worse over the past 12 months. Looking ahead, 43% think standards will deteriorate further. Only 15% of the public thinks social care services in their local area are good, while 31% disagree.
• After the Health and Social Care Levy came into effect – a 1.25 percentage point increase in national insurance contributions to help fund the NHS and social care – 52% of the public still supports the levy, while 23% oppose it. The strongest support (68%) for the levy is found among Conservative voters.
• The public wants a better health service, not a different health system. 77% believe, ‘The NHS is crucial to British society and we must do everything to maintain it.’ And they back additional spending to support it: 71% think greater government investment in the NHS is necessary over and above new funds raised through the levy.
• The public is deeply concerned about the impacts of rising costs of living on the nation’s health. 57% think rising living costs are a high or very high threat to the health of UK citizens. 72% believe overall health and wellbeing has declined in the past 12 months.
• A minority believe the government is effectively addressing the leading risk factors for ill health. Fewer than 1 in 5 people believe the government is working effectively to improve physical activity (19%), improve diets (17%), reduce alcohol-related harm (16%) and reduce obesity (14%).
• Overall, our analysis shows high levels of concern among the public about the standards of NHS and social care services. It also reflects the public’s anxieties around the cost-of-living crisis and the threat this poses to health. It is hard to see how the new prime minister can reconcile her commitments to cut taxes and shrink the state with addressing the concerns of the public. Failing to do so risks leaving the government out of step with the public as we head towards the next general election.

The challenges facing the new prime minister

The UK has a new prime minister, but the problems facing health and social care are all too familiar. Waiting lists for routine hospital treatment in England are long and growing – reaching 6.7 million by June 2022. Pressures on emergency departments are severe and people are finding it harder to access their GP practice. The NHS is trying to meet these pressures with an exhausted and overstretched workforce while managing the ongoing impact of COVID-19. Vacancies in NHS trusts are now around 132,000 and staffing gaps are projected to grow.

Public satisfaction with the health service has fallen to a 20-year low. By the end of 2021, the ‘grace period’ of widespread support for the NHS and its staff during the pandemic, had been replaced by a more pessimistic outlook. Public satisfaction fell across all NHS services – from emergency care in hospitals to general practice and dentistry.

Satisfaction with social care is even lower. Early in the pandemic, high numbers of deaths in care homes and the impossible pressures on care workers put the sector in the spotlight. This spotlight has dimmed, yet social care remains under extreme strain from chronic underfunding and widespread staff shortages, leaving many people without the care they need., These pressures are less visible than in the NHS, but are no less severe – and challenges in both systems interact to cause escalating problems for people using and providing services. COVID-19 has made these problems worse, but their causes are longstanding – including a decade of austerity in public spending, political neglect of adult social care, and limited health system capacity, such as staff, beds and equipment.

The 2019 general election gave Boris Johnson’s government a substantial majority to deliver on pledges to ‘level up’ the UK, ‘fix’ social care and strengthen the NHS. These manifesto ambitions initially took a backseat to the pandemic response. But since then ministers have produced policy at frenetic pace – with white papers on the health service, social care, integration of care and levelling up, alongside the biggest shake-up of the NHS in England in a decade. Yet Liz Truss inherits a health and care system in crisis and widening health inequalities., The task facing the new prime minister and her government is significant. As the Truss government sets out its agenda on health and social care, understanding what the public thinks should inform policy.

About this report

This report presents findings from the second survey in our programme of research into public perceptions of health and social care, delivered in partnership with Ipsos. Every 6 months, we poll a representative sample of the UK public using the UK KnowledgePanel – Ipsos’ random probability online panel.

The report covers public perceptions of health policy and performance in five areas: the NHS, social care, NHS and social care funding, public health, and the government’s handling of the COVID-19 pandemic. The final section discusses the implications of our findings for national policy.

Unless stated otherwise, all findings reported are for the UK overall. Given the recent change in UK prime minister, our discussion of implications at the end of the report focuses mainly on what our analysis means for policymakers in England, as health policy in the UK is devolved to politicians in Scotland, Wales and Northern Ireland.

Methods

The UK KnowledgePanel has over 18,000 panellists who are recruited using random probability address-based sampling, the gold standard in survey research. This means that every household in the UK has a known chance of being selected to join the panel. Invited members of the public who are digitally excluded can register to the KnowledgePanel either by post or by telephone, and are given a tablet, an email address and basic internet access allowing them to complete the online survey.

A total of 3,600 respondents were invited to take part in the survey. The sample was reviewed on key demographics to ensure a balanced sample was selected. Weighting was applied to the data to ensure the survey results are as representative of the UK population as possible. A total of 2,068 respondents completed the survey, representing a response rate of 57%. Further details about the methodology and the UK KnowledgePanel are provided in the accompanying Ipsos report.

The survey was conducted between 26 May and 1 June 2022. Fieldwork started on the day the Sue Grey report into ‘partygate’ was published and was completed before the platinum jubilee and Boris Johnson’s resignation as prime minister. The NHS waiting list in England had recently reached yet another record high, with reports of severe pressures on ambulance services and A&E departments.

Throughout the report, we highlight differences between different subgroups of respondents where these are relevant to the question and statistically significant at the 95% confidence interval. We also analyse changes in results from our previous survey, conducted in November 2021, and other surveys using comparable methods. Comparisons of results to surveys conducted before July 2021 are only indicative – all used a different geographical sample (Great Britain instead of the UK) and age range (18 years and older instead of 16 years and older), with different methods for surveys undertaken prior to March 2021 (telephone omnibus rather than online KnowledgePanel).

Social care was in crisis before the pandemic, following years of underfunding, understaffing and market fragility. COVID-19 magnified these problems, with devastating consequences for people who use and provide services.

One of Boris Johnson’s first pledges as prime minister in 2019 was to ‘fix the crisis in social care once and for all’ and government’s flagship social care reform – the social care cap in England – was announced in September 2021. Under the policy, the amount anyone will need to spend on personal care during their lifetime will be capped at £86,000 from October 2023. But last-minute changes made the policy less fair and generous for people with lower levels of wealth, and reduced protection against high care costs. The reforms also leave major problems in the system unaddressed, including high unmet need, poor terms and conditions for staff, and widespread staff shortages, currently estimated at over 165,000.

The public is still unclear how social care works and is funded

The social care system is not well understood by the public. For this reason, our survey reminded people that social care means services that help people in need of practical support due to illness, disability, old age or other reasons. Research undertaken in 2018 found people tended to think the social care funding system is more generous than it actually is, with many assuming the service is free at point of use, like the NHS. There are important differences in the way publicly funded social care is accessed across the UK, but in all countries people face both needs and means tests.

A sizeable minority of the public are still unclear about who provides social care and how care is funded. Nearly a third (31%) incorrectly think that the NHS provides the majority of social care services for older people (Figure 7). A further 38% incorrectly think that social care services are generally free at the point of need. There were no significant differences in these perceptions between the UK nations.

Views on the standard of social care over the past 12 months remain negative

Perceptions of what has happened to the general standard of social care over the past 12 months are negative, but slightly less so than in November 2021. Just over half of the public (56%) think standards got worse over the past 12 months and only 5% think standards improved (Figure 8a). People with experience of using services during this time are less negative (45%), but those from older age groups are more likely to think standards have deteriorated, including 69% of those aged 65–74 years and 64% of those aged 55–64 years.

The public is pessimistic about the future of social care and few think government has the right policies

Looking ahead, the public is pessimistic about whether the general standard of social care will improve – but slightly less negative than November 2021. Less than half (43%) think standards will get worse over the next 12 months, while 13% expect standards to get better (Figure 8b). Older age groups are again more pessimistic – around half of people aged 55–64 years (51%) and 65–74 years (48%) think standards will get worse, compared with 23% of those aged 16–24 years.

Despite the government’s plan to cap individual care costs in England, the public remains overwhelmingly unsatisfied with the government’s handling of social care. Fewer than 1 in 10 (8%) think that government has the right policies in place for social care and more than half (59%) disagree. These findings remain largely unchanged from November 2021.

Few think their local social care services are providing good-quality care

Just 15% of the public thinks social care services in their local area are good, while 31% disagree. Views remain broadly unchanged from November 2021. However more of the public (23%, up from 1% in 2021) ‘don’t know’ either way, further confirmation that awareness and understanding of social care is limited.

People who use social care services are more positive about the quality of social care, with 27% agreeing that local services are good and 38% disagreeing. However, people in older age groups are more pessimistic. Only 9% of those aged 65–74 years think local social care services are good, compared with 25% of those aged 16–24 years.

The social care spending cap is broadly supported, but awareness is low

9 months after the government announced plans to cap social care costs in England, more than half of people living in England (58%) are still unaware of the policy, with 40% aware (Figure 9a). When the policy is explained to people, just under half (49%) support the policy, 21% oppose it and 25% neither support nor oppose it (Figure 9b).

We asked those who do not support the spending cap to explain their reason in an open-ended response. Reasons given include that the policy does not go far enough in protecting people from catastrophic costs, that the policy is not fair for people who earn less, and that it is a disincentive for people to save.

Most people are not making financial preparations for social care

The public is more likely than not to agree it is their responsibility to financially prepare for their future social care needs. Less than half of the public (44%) think it is their responsibility and around a third (35%) disagree. Those aged 16–24 years are more likely to think it is their responsibility (63%) than the population overall (44%). In 2017, a larger proportion agreed it was their responsibility (55%), though comparisons are indicative only.

But only 4 in 10 (40%) have thought about preparing financially for their social care. And even fewer (30%) are already preparing financially, with just 5% having done so to any great extent (Figure 10).

In September 2021, Boris Johnson announced new spending for the NHS and social care funded by a 1.25 percentage point increase in national insurance contributions – known as the Health and Social Care Levy. The levy was effectively introduced from April 2022.

Since then, politicians have become increasingly divided over the national insurance rise. Labour indicated the party would scrap the increase given the rising cost of living. Conservative backbenchers have grown increasingly uneasy over the increase to national insurance, which breaks a key manifesto promise. While Chancellor, Rishi Sunak resisted pressure to scrap the levy, but raised the national insurance threshold from July 2022 (essentially reducing the amount of money the levy will raise) and announced that an income tax cut would follow in 2024.

Tax and spending were a key theme of the Conservative leadership campaign. During the campaign, Liz Truss pledged to scrap the national insurance increase as part of a wider £30bn package of tax cuts intended to boost economic growth and ease the cost of living. However, the new prime minister has been less forthcoming about the implications of her plans for the funding available to public services, including the NHS and social care.

Support for the Health and Social Care Levy remains, but has dropped slightly

Our November 2021 survey took place after the levy was announced but before any tax rise was implemented. At that time, we found that most people (58%) supported the levy and only a fifth opposed it.

People first felt the impact of the policy in April 2022, when the increased national insurance rates came into effect. Our survey in May 2022 found support for the levy remains, but has dropped slightly since November 2021 (Figure 12). Just over half (52%) of the public still support the levy, while 23% oppose it.

Support for the levy is highest among older people past retirement age (71% of those aged 65–74 years and 63% of those aged 75 years and older) and lowest among younger age groups (40% aged 16–34 years). Conservative (68%) and Liberal Democrat (62%) voters are also more likely to support the levy than Labour voters (52%).

In the context of rising concerns about the increasing cost of living, the continued support for the levy suggests the public wants the government to invest in improving NHS and social care services. Health Foundation analysis suggests that even with the new funds raised by the levy, NHS funding will not be enough to make improvements to care. Assuming the prime minister follows through on her commitment to scrap the levy, the government will need to replace the revenue the levy would have raised through other means or be open with the public about the implications of cutting NHS and social care funding by £13bn per year.

Most think the NHS needs a further increase in funding

Overall, the public is fairly divided on the right level of public spending: 28% think spending should be higher than before the pandemic, 30% the same and 24% lower. But the NHS remains the public’s main priority for public spending, followed by social care for older people.

The public tends to think that further public spending on the NHS is needed. The majority (71%) think that the NHS needs a further increase in funding beyond the new levy, compared with 22% who think that the NHS does not need further funding and should operate within its current budget (Figure 12). Views are divided along party lines. The vast majority of those intending to vote Labour (86%), Liberal Democrat (82%) or Green Party (87%) believe the NHS needs more funding, compared with just over half (52%) of those intending to vote Conservative.

While the majority of the public think the NHS needs more funding, there is less agreement over how any increases for the NHS or social care should be funded. When people were asked how they think such funding increases should be raised, the most popular proposals across both services included increasing income tax, increasing inheritance tax, and making spending cuts to other services (Figure 13). With the NHS accounting for an ever-increasing share of day-to-day government spending, the prospect of cutting other areas of spending would present policymakers with difficult decisions, especially in the context of the new prime minister’s pledge to cut taxes.

Improvements in life expectancy in England had stalled before COVID-19, but the pandemic brought longstanding health inequalities into focus. People from ethnic minority communities and disabled people were among those at greater risk of dying from COVID-19. In plans to ‘level up’ the UK, government committed to improve life expectancy by 5 years by 2035 and reduce geographical inequalities in healthy life expectancy by 2030. But as living standards fall and the cost of living rises, concerns remain around the future of the nation’s health – particularly the most vulnerable.

The public believe overall health and wellbeing has declined, but are more positive about the next 12 months

The public is pessimistic about how the overall health and wellbeing of the nation has changed over the past 12 months. Nearly three-quarters (72%) believe overall health and wellbeing has declined, while only 9% think it has improved. People living in Scotland (84%) are more likely to believe that overall health has declined in the past 12 months.

Expectations of how overall health and wellbeing will change over the next 12 months are more divided: 43% think overall health will get worse, 20% believe it will improve and 34% expect no change.

The cost-of-living crisis is seen as a threat to the nation’s health

UK households are facing the biggest fall in living standards since the 1950s. In June 2022, 91% of adults reported their cost of living had increased in the past month. The Johnson government provided a support package to assist with easing the burden of rising costs – and soaring energy bills in particular – for families and vulnerable groups. But this is unlikely to mitigate the risk of poverty and hardship that millions face heading into winter, and it remains to be seen what the Truss government will offer in the way of further targeted support.

The public is overwhelmingly worried about the rising cost of living: 92% of people are concerned, with 59% very concerned and just 7% not concerned. But some groups – such as people in Scotland (98%) and those in the middle deprivation quintile (96%) – are more likely to be worried.

More than half (57%) of the public think the rising living costs represent a high or very high threat to the nation’s health (Figure 14). However, the public is most likely to perceive the cost-of-living crisis as a threat to the health of the population, rather than to their own health or to their family. Only around 1 in 5 (22%) believe it poses a high threat to their health personally, compared with 39% who believe the threat to their own health is low. People are more likely to believe the threat to their family’s health is low (35%) than high (25%).

Those most vulnerable to rising living costs are more likely to perceive it as a threat to their health personally. Those with incomes up to £25,999 (29%) and those living in deprived areas (34%) are more likely to perceive it as a high threat to their own health compared with the population overall (22%).

Government is not seen to be taking effective action on the major health risk factors

The leading health risk factors – physical inactivity, smoking, poor diet and harmful alcohol use – drive the significant burden of preventable ill health and premature death. Government aims to make progress in these areas, and has introduced policies such as an increased tax duty on tobacco, and the soft drinks industry levy. But the approach to addressing risk factors has so far been uneven and largely focused on changing individual behaviour instead of implementing population-level interventions, such as regulation and product reformulation, that apply to everyone and are more likely to be equitable and effective.

Fewer than 1 in 5 people believe the government is working effectively to improve physical activity (19%), improve diets (17%), reduce alcohol-related harm (16%) and reduce obesity (14%) (Figure 15).

The effectiveness of government’s action on harmful smoking is judged more favourably – though the public is still slightly more likely to think action has been ineffective (49%) than effective (46%). Overall smoking rates have decreased in England from 19.8% in 2011 to 13.9% in 2019, although England is unlikely to meet its target to become smokefree by 2030 without more ambitious action.

The public is least likely to think that government intervention has been effective around reducing obesity. Only 14% believe that government is effectively reducing obesity while the vast majority (82%) disagree. The new prime minister’s pledge to scrap restrictions on multibuy deals, recently delayed by the Johnson government alongside limits on advertising less healthy food and drink on TV and online, may run counter to public opinion.

The public tends to agree that government should focus more resources on preventing ill health over treatment

While spending on the NHS has increased in real terms over the past decade, the public health grant – paid to local authorities to fund vital services – has been cut by 24% between 2015/16 and 2021/22 on a real-terms per person basis. Real-term cuts to the grant have tended to be greater in more deprived areas.

But our survey illustrates that the public is more likely than not to support an approach to health that prioritises prevention over treating illness. Around two-fifths (42%) are more inclined to agree that government should focus resources on preventing ill health, even if this means there will be less funding for treating people in hospital (Figure 16). 27% agree more that government should focus on treating illness, even if this means there are more people in the population with health conditions that could be prevented. Around a quarter (26%) agree equally with both statements.

Source: Ipsos survey commissioned by the Health Foundation, 2022. Conducted online via KnowledgePanel UK between 26 May and 1 June 2022. Base: 2,068

In winter 2021, the UK government implemented ‘Plan B’ measures in efforts to reduce the spread of the Omicron variant and expanded the vaccination programme to offer booster doses to all adults in England. Governments in England, Scotland, Wales and Northern Ireland have all since published strategies for ‘living with COVID-19’ and virtually all restrictions were lifted in spring 2022. Meanwhile a UK-wide public inquiry into the government’s response to COVID-19 has been established with hearings expected to start in 2023. A separate inquiry in Scotland will be undertaken in parallel.

The public is largely relaxed about the move to ‘living with COVID-19’

The majority of the public (66%) are not concerned about the move to ‘living with COVID-19’, while around a third (33%) are. Disabled people or people with a long-term health condition are more likely to be concerned (43%). Those from ethnic minority backgrounds are also more likely to be worried (47%) than those from white ethnic backgrounds (30%).

Those with concerns about living with COVID-19 were asked to indicate their biggest concerns from a predefined list. The biggest concern, selected by just under half (48%), is that clinically vulnerable people will be more likely to get COVID-19 (Figure 17). The other most common concerns are that people will not be able to access the NHS or social care services for conditions not related to COVID-19 (33%), people generally being more likely to get COVID-19 (32%) and more people needing treatment for long COVID (31%).

In general, those with concerns are most worried about the impact on individuals and least concerned about the potential consequences for the health and care system. High levels of staff illnesses in general, and in public services, are not the most pressing concerns. Only a quarter selected high levels of staff illnesses at GP practices, hospitals and care homes as one of their biggest concerns.

The move to ‘living with COVID-19’ has not changed views about government’s handling of the pandemic

Over half (55%) of the public believe that government has not handled the pandemic well so far, while 44% believe it has been handled well.

There are some stark generational differences in views – people aged 75 years and older (71%) are far more likely to believe that the pandemic has been handled well compared with those aged 16–24 years (22%). Young people’s wellbeing has been hard hit by the pandemic. They have faced disproportionate job losses, the closure of colleges and universities and cancellation of exams, creating significant uncertainty around their future. Public perceptions of the government’s handling of the pandemic have not changed since November 2021, although the context of the pandemic has evolved significantly since then.

Around half think that government is not more prepared for a future pandemic as a result of COVID-19

Investigations have uncovered weaknesses in government’s pandemic preparations and risk management prior to the initial outbreak. In adult social care, underlying structural issues in the sector contributed to a fragmented and slow pandemic response. The pandemic is an opportunity for government to strengthen its preparedness for future health emergencies.

However, the public is split on whether COVID-19 has left the government better prepared for a future pandemic – 46% are confident, but 52% are not. Opinion is divided along party lines. Conservative voters are far more likely to be confident (84%) than the public overall, while those voting Labour are more likely to say they are not confident (66%) compared with the public overall. The government clearly has some way to go to demonstrate to the public that lessons have been learned.

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