Last month, Wes Streeting used his first speech as health secretary to declare the NHS “broken” and going through “the biggest crisis in its history.” And most of the public would agree: trust in the health service is at a record low.
Between 2008 and 2024, the share of Britons who felt the NHS would be there for people when they need it declined from 82 per cent to 66 per cent, according to researchers from King’s College London and Ipsos. Almost one in five (18 per cent) believe that it won’t.
The same study also found that half the population have decided against seeing an NHS GP about a health condition in the last year—many because they thought they either wouldn’t get an appointment, wouldn’t get through on the phone or would face waiting times that were too long. Of those, 45 per cent say their condition either remained the same or became worse.
The points are connected: those who have not sought out GP care are more likely to feel that they can’t rely on the NHS, the researchers found. For Sam van Elk, part of the King’s College London team, this was the most striking finding: “It’s certainly one thing to think that the NHS might not be there when you need it but another to act in line with that fear,” he says.
For nearly a decade, the NHS has experienced a significant slowdown in funding growth, while demand for services has grown rapidly. Hospital waiting lists have lengthened, and satisfaction with NHS care has declined. Trust has broken down with this “broken” system which urgently needs to make big changes.
The Labour party 2024 general election manifesto lists a series of measures to “get the NHS back on its feet”, which includes incentivising staff to deliver 40,000 more appointments every week out-of-hours, and pooling resources across hospitals to introduce shared waiting lists. It also includes using spare capacity in specific areas of the independent sector, such as delivering elective surgeries and procedures so patients can be treated more quickly. It is unclear how much capacity the independent sector can contribute and how much this would cost.
Nick Krachler, a lecturer in human resource management at King’s Business School and another researcher on the project, argues that the private sector is not a feasible solution for the waiting list issue. “The private sector doesn’t have much capacity that the NHS doesn’t already have,” he says, adding that this is because “much of the private sector's capacity comes from NHS employees (particularly physicians but also specialist nurses) who do extra private work to top up their income.”
If the government is to restore NHS standards and people’s trust, it will have a lot of work to do. For Krachler, in addition to meeting hard targets on, for example, reducing waiting times, the government should focus on employees’ psychological and economic wellbeing. The latest NHS staff survey, conducted in 2023, shows that 30 per cent of staff feel burnt out because of their work, and just 31 per cent are satisfied with their level of pay.
By focusing on these areas, along with increased funding for service provision, the government “will likely progress in restoring the service over the next five years,” Krachler says. He adds that this must be done without demanding staff productivity increases in return.
Last week, Rachel Reeves confirmed a 5.5 per cent pay rise for NHS workers and the BMA recently offered junior doctors a 22.3 per cent average pay increase over two years to avoid widespread strikes which have caused disruption to the NHS for the last two years.
If there is increased pay for workers, and the healthcare provision improves as a result, as Krachler hopes it will, trust may bounce back. If the government were to secure a second term and continues to work on sustainably improving NHS employee wellbeing and capacity, Krachler says, “it can restore the service close to what it was before the Conservative-led governments.”
“People trust processes as much as outcomes” adds van Elk, who believes that demonstrable improvement in services, even if they aren’t restored entirely to pre-austerity levels, “could do a great deal to restore trust.”
