As the NHS turns 75, Paula Surridge unpacks what the public think about the health service and how it has been impacted by Brexit. She highlights that while satisfaction has fallen significantly since 2019, so too has the salience of the NHS as an issue relative to concerns about the cost of living and the economy.
5 July 2023 marks the 75Th birthday of the NHS. Described by Nigel Lawson in 1992 as ‘the closest thing the English have to a religion’, there is no question the NHS remains a cornerstone of British identity. Recent polling from Ipsos found that more than half of those who identified as British citizens said the NHS was what made them most proud to be British. The foundational principles of the NHS – free at the point of use, universally available and funded through taxation – retain the support of the public.
Despite (or perhaps because of) this, satisfaction with the service provided by the NHS has declined dramatically since 2019, and reached an all-time low in 2022.
The British Social Attitudes series has tracked public attitudes to the NHS since 1983. While there were periods in the late 1980s and early 1990s where the public were more likely to be dissatisfied with the NHS than satisfied, there has been a dramatic fall in satisfaction levels since 2019.
As with so many of the trends we see, it is not possible to say whether this fall in satisfaction is a post-Covid effect, a post-Brexit effect, or more likely the combined impact of these factors and the ongoing crises in waiting times across the health service.
But while we can’t directly disentangle these effects, we can look at how voters think the NHS has been impacted by Brexit and the expectations they had about this at the time of the referendum.
The bright red bus suggesting leaving the EU could mean an extra £350 million pounds a week for ‘our’ NHS became an iconic image from the campaign to Leave the EU in 2016. From British Election Study Internet Panel data collected during the 2016 campaign it is clear that few voters thought the NHS would be worse off outside the EU, even if they were sceptical that leaving would mean more money for the NHS.
Among those who voted to Leave, just 4% said they expected the NHS to be worse off as a result of Brexit, while almost two-thirds expected that the NHS would be better as a result of leaving the EU. And while those who voted Remain were less optimistic, around 1 in 10 thought the NHS would be better, and Remain voters were more likely to say the NHS would be unaffected than decline.
However, our data tracking public opinion on Brexit since 2022 suggests that many voters now believe that leaving the EU has in fact made the NHS worse than it would have otherwise been.
Since early 2022 we have been asking voters regularly whether they think different aspects of life have got better or worse as a result of being outside the EU.
The first time we asked about the NHS in February 2022, 30% of Leave voters thought the NHS had got worse, as did 60% of Remain voters. From August 2022, the proportion of Leave voters saying the NHS was worse because of Brexit rose to more than 40% and has remained at this level for the last 12 months.
There has also been a small rise in the proportion of Remain voters saying the NHS is worse outside the EU, peaking in February 2023.
What does all this mean for the role of the NHS in British politics as we approach the next general election? The NHS is certainly a key part of our national identity and is widely perceived as being in crisis. But is it a significant driver of voting behaviour?
At the time of the 2019 general election, Ipsos found that the NHS was one of the three most important policy issue for more than half of voters, though only the top concern for 16%. In comparison, and despite widespread dissatisfaction with the NHS, in the most recent Ipsos issues index, just 27% of voters cited the NHS as one of their top three issues and just 7% as their most important issue – as inflation and the economy dominate.
This nicely tells the story of the electorate’s relationship with the NHS. It has been persistently a concern, but rarely their greatest one, and so consistently less salient for voting than other issues such as the economy or cost of living.
While the NHS – and the impact of Brexit on it – are difficult terrain for the Conservatives, it is unlikely to prove to be critical in an electoral landscape dominated by concerns with inflation, mortgages and prices.
By Paula Surridge, Deputy Director, UK in a Changing Europe.