The NHS at the heart of the election
What do politicians have to say?
Jonathan Nicholls
Head 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”
How would you vote if there were a General Election tomorrow?
All giving a voting
intention (78%)
All certain to
vote (52%)
Other
11%
Other
12%
Con
LD
38%
17%
Lab
34%
Conservative lead = +4
LD
16%
Lab
40%
Con
32%
Conservative lead = +8
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
Source: Ipsos MORI Political Monitor
Voting Intentions Jan 03 – January 10
(all certain to vote)
How would you vote if there were a General Election tomorrow?
Howard elected
(Nov 03)
50
2005
Brown as PM
General
(Jun 07)
Election
Cameron elected
(Dec 05)
40%
40
32%
30
20
16%
10
Jan-10
Nov-09
Sep-09
Jul-09
May-09
Mar-09
Jan-09
Nov-08
Sep-08
Jul-08
May-08
Mar-08
Jan-08
Nov-07
Sep-07
Jul-07
May-07
Mar-07
Jan-07
Nov-06
Sep-06
Jul-06
May-06
Mar-06
Jan-06
Nov-05
Sep-05
Jul-05
May-05
Mar-05
Jan-05
Nov-04
Sep-04
Jul-04
May-04
Mar-04
Jan-04
Nov-03
Sep-03
Jul-03
May-03
Mar-03
Jan-03
0
Base: c. 1,000 British adults each month through June 2008; c. 500 British adults thereafter
Source: Ipsos MORI Political Monitor
Comparing Leaders
Which leader do you think … Gordon Brown, David Cameron or Nick Clegg?
Brown
Cameron
…is more honest than most
politicians
10%

…best understands the problems
facing Britain?
Base: 1,003 British adults 18+, 25th-27th September 2009
43%
10%
10%
12%
…would be best in a
crisis?
…is most out of touch with
ordinary people?

25%
19%
27%
19%
25%
…best understands world
problems?
Don’t know
Neither
Clegg
37%
34%
9%
10%
10%
28%
4%
46%
10%
12%
15%
11%
8%
33%
33%
Source: Ipsos MORI Political Monitor
Net satisfaction with Opposition Leaders
(1994 – 2009)
How satisfied or dissatisfied are you with the way … is doing his
job as leader of the … Party?
40
30
BLAIR (1994-1997)
CAMERON (2005-?)
Net satisfied
20
10
0
Number of months from becoming leader
-10
-20
HOWARD (2003-2005) HAGUE (1997-2001)
-30
-40
DUNCAN SMITH (2001-2003)
Note: methods change for Cameron; see below
-50
Base: c.1,000 British adults interviewed 3rd week of the month
Note: Data collected prior to May 2008 was collected via face-to-face
methodology; data collected from June 2008 was via telephone
Source: Ipsos MORI Political Monitor
So what does all this mean
– good news for Lib Dems?
How would you vote if there were a General Election tomorrow?
Conservative lead
Labour lead
20
General Election ’05
(Labour majority of 66 seats)
Est. Labour
lead required
for a Labour
overall
majority
Est. Cons’ve
lead required
for a Cons’ve
overall
majority
10
0
10
20
30
40
Jan
2003
Jul
2003
Jan
2004
Jul
2004
Jan
2005
Jul
2005
Jan
2006
Base: c. 1,000 British adults each month
Jul
2006
Jan
2007
Jul
2007
Jan
2008
Jul
2008
Jan
2009
Jul
2009
Jan
2010
Source: Ipsos MORI Political Monitor
What about views on
the NHS?
Highest levels of satisfaction with the NHS
Q
Overall, how satisfied or dissatisfied are you with the running of the
National Health Service nowadays?
% Satisfied
Satisfied
67
70
60
50
40
30
Dissatisfied
18
20
10
20
00
Sp
rin
20
g
01
W
in
20
te
r
02
Sp
rin
20
g
02
W
in
20
te
r
03
Sp
rin
20
g
03
W
in
20
te
r
04
Sp
rin
20
g
04
W
in
te
20
r
05
Sp
rin
20
g
05
W
in
20
te
r
06
Sp
rin
20
g
06
W
in
te
M
r
ar
ch
20
07
Ju
ly
20
07
D
ec
20
07
M
ar
ch
20
08
Ju
n08
0
Base: English adults aged 16+ (c.1,000 per wave)
Source: Ipsos MORI Perceptions of the NHS Tracker
General upward trend in satisfaction…
% satisfied
95%
GPs 91%
90%
85%
80%
Outpatients 86%
Inpatients 85%
75%
A&E 74%
70%
65%
NHS overall 67%
60%
55%
20
02
Sp
rin
g
20
03
W
in
te
r2
00
3
Sp
rin
g
20
04
W
in
te
r2
00
4
Sp
rin
g
20
W
05
in
te
r2
00
5
Sp
rin
g
20
W
06
in
te
r2
00
6
M
ar
-0
7
Ju
l-0
D 7
ec
-0
7
M
ar
-0
8
Ju
n08
in
te
r
W
Sp
rin
g
20
02
50%
Base: English adults age 16+ (c.1,000 per wave)
* Small base size means comparison of figures
and trends is indicative only
Source: Ipsos MORI Perceptions of the NHS Tracker
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
My local NHS is providing me with a good service
80
74
70
The NHS is providing a good service nationally
60
52
50
40
The government has the right policies for the NHS
30
26
20
10
0
Winter
2003
Spring
2004
Winter
2004
Spring
2005
Winter
2005
Base: English adults aged 16+ (c. 1,000 per wave)
Spring
2006
Winter
2006
March
2007
Dec
2007
March
2008
Jun-08
Source: Ipsos MORI Perceptions of the NHS Tracker
Satisfaction with NHS less linked with attitudes
towards government than in the past
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?
70
60
50
40
73
% Satisfied with current
running of NHS
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.
30
25
20
% Satisfied with way government
is running the country
D
e
Ja c-0
Fe n- 06
M b-0 7
a 7
A r-0
M pr- 7
a 0
Juy- 0 7
n 7
Ju -0
A l- 7
u 0
S g- 7
e 0
O p-0 7
N ct -07
o
D v -07
e
Ja c-0 7
Fe n- 07
M b-0 8
a 8
A r-0
M pr- 8
a 0
Juy- 0 8
n 8
Ju -0
A l-08
u
S g- 8
e 0
O p-0 8
N ct -08
o
D v -08
e
Ja c-0 8
Fe n- 08
M b-0 9
a 9
A r-0
M pr- 9
a 0
Juy- 0 9
n 9
Ju -0
A l-09
u
S g- 9
e 0
O p-0 9
N ct -09
o
D v -09
ec 9
-0
9
10
Source: Ipsos MORI/DH Public Perceptions of the NHS Tracker, Ipsos MORI Political Monitor
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)
NHS has fallen as an issue facing Britain
What do you see as the most/other important issues facing Britain today?
Economy
70
60
50
Crime/
Law &
Order
Race/
immigration
40
30
20
NHS
10
Unemployment
0
May
1997
May
1998
May
1999
May
2000
May
2001
May
2002
May
2003
May
2004
Base: representative sample of c.1,000 British adults age
18+ each month, interviewed face-to-face in home
May
2005
May
2006
May
2007
May
2008
May
2009
Source: Ipsos MORI Issues Index
Key election issue: the economy stupid
… but health also important
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*
All at 3% and above
39%
Managing the economy
20%
Healthcare
17%
15%
13%
10%
Education
Unemployment
Asylum/ immigration
Taxation
Defence
Crime/ anti-soc. behaviour
Protecting the environment
Afghanistan
Pensions
Party leader/policies
Europe
6%
6%
6%
6%
5%
5%
3%
Base: 1,003 British adults 18+, 25th-27th September 2009
NOTE: Trend is from a face-to-face, prompted question. This year’s question is asked open-ended.
+4
-2
-5
+10
-1
-8
+2
-12
-4
n/a
-4
n/a
0
Source: Ipsos MORI Political Monitor
Which party has the best policies on … ?
% who think issue is ‘very
important’ in helping them
decide how to vote
Labour
Managing the economy
39
Healthcare
20
Education
Conservatives
Lib Dems
30%
12%
22%
37%
10%
17
15
15%
Taxation
Crime & anti-social
behaviour
Defence
13
-2
27%
-5
11%
15%
10%
10
18%
25%
23%
6
20%
+14
+2
31%
6
-15
27%
29%
29%
Asylum/ immigration
+5
25%
22%
Unemployment
Conservative lead over
Labour
+11
9%
24%
21%
10%
Base: 1,003 British adults 18+, 25th-27th September 2009
NB. Figures exclude ‘don’t know’, ‘none’ and ‘other’ responses
+3
Source: Ipsos MORI Political Monitor
The elephant in the room….
Green shoots?
Employment levels, rebased*
Recession starting in
102
1980 Q1
1990 Q3
2008 Q3
!
100
98
96
94
92
1
2
Source: ONS/Economist
3
4
5
Years since start of recession
6
7
*Quarter before start of recession = 100
8
Over the next three years…
The problem is that this
isn’t registering….
People apprehensive about NHS over next few
years – but its not about financial crunch
Thinking about the NHS over the next few years do you expect it
2005 General Election (May
to get better/worse?
Brown as PM (Jun 07) –
Johnson replaces Hewitt as
05) – Hewitt replaces Reid
% net
better
1p rise in National
Insurance for NHS (Apr
02)
Reid replaces
Milburn as Health
Secretary (Jun 03)
15
-15
Burnham replaces
Johnson as
Health Secretary
(Jun 09)
Cameron elected
(Dec 05)
14
9
5
-5
Health Secretary
as Health Secretary
-2
1
1
-7
-5
-12
-4 -2
-11
-23
-25
-14
-19
-11
-8
-15
-27
-32 -30
-35
9
v-0
No 9
n-0
Ju 8
p -0
Se 8
r -0
Ma 7
v-0
No 7
p -0
Se 7
y-0
Ma 7
r -0
Ma 6
v-0
No 6
p -0
Se 6
y-0
Ma 6
r-0
Ma 5
v-0
No 5
p -0
Se 5
y-0
Ma 5
b-0
Fe 4
v-0
No 4
p -0
Se 4
n-0
Ju 4
r-0
Ma 3
c-0
De 3
p -0
Se 3
n-0
Ju 3
r-0
Ma 2
c-0
De 2
p -0
Se 2
y-0
Ma 2
r -0
Ma
Base: c.1,000 British Adults
Source: Ipsos MORI
The Ipsos MORI Economic Optimism Index
Do you think that the general economic condition of the country will
improve, stay the same or get worse over the next 12 months?
40
+28
Index (get better minus get worse)
+23
+20
20
0
-4
-4
-20
-40
Base: c. 1,000 British adults each month
Oct '09
May '09
Dec '08
Jul '08
Feb '08
Sep '07
Apr '07
Nov '06
Jun '06
Jan '06
Aug '05
Mar '05
Oct '04
Jun '04
Jan '04
Aug '03
Mar '03
Oct '02
May '02
Dec '01
Jul '01
Feb '01
Sep '00
Apr '00
Nov '99
-56
Jun '99
Jan '99
Apr '98
Nov '97
Jun '97
Jan '97
-80
Sep '98
-46
-60
Source: Ipsos MORI Political Monitor
A denial of seriousness of national debt…
To what extent do you agree or disagree with each of the following
statements about public services in Britain?
% Strongly agree
% Tend to agree
% Tend to disagree
Making public services more
efficient can save enough money
to help cut government spending,
without damaging services the
public receive
There is a real need to cut
spending on public services in
order to pay off the very high
national debt we now have
38
18
% Strongly disagree
41
22
22
8 5
29
40%
Source: Ipsos MORI Public Spending Index
Base: 1,004 British adults, 19-21 June 2009
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?
% Agree
Making public services more
efficient can save enough money
to help cut government spending,
without damaging services the
public receive
There is a real need to cut
spending on public services in
order to pay off the very high
national debt we now have
% Disagree
75
24
Base: 1,041 online British adults aged 16-64, 4-7 Sept 2009
9
50
Perhaps because most people don’t feel
personally squeezed
How would you describe the current state of…
% Very good
% Fairly good
The British
18
economy
The economy in
1
your local area
Your personal
finances
% Fairly poor
40
50
33
10
Base: 984 British adults, 15th May – 21st May 2009
% Very poor
40
57
19
21
10
Source: Ipsos MORI
Why is this a problem
for the NHS?
Consistent view it should be protected
% Q10 Which of the following statements best reflects your thinking about the NHS?
90
The NHS is
crucial to
73
British society
73
and we must
72
do everything
to maintain it
80
70
60
50
All
ABC1
C2DE
The NHS was a
great project
27
but we
25
23 probably can’t
maintain it in its
current form
40
30
20
10
tr
Q
1s
t
20
07
r2
00
6
6
in
te
g
20
0
W
Sp
rin
r2
00
5
5
in
te
g
20
0
W
Sp
rin
r2
00
4
4
in
te
20
0
Base: English adults age 16+ (c.1,000 per wave)
W
g
Sp
rin
r2
00
3
3
in
te
g
20
0
W
Sp
rin
r2
00
2
2
in
te
W
Sp
rin
g
20
0
20
01
20
00
0
It will provide me with everything I need
… = no limits on spending
The NHS should provide the most
effective drugs and treatments
provided they represent good value
for money
28%
The NHS should
provide the most
effective drugs and
treatments no matter
what they cost
41%
Base: British public, 18+ (1,001) 12-17 January 2006
31%
The NHS should
provide all drugs
and treatments
no matter what
they cost
72% expect NHS to
provide drugs no
matter what they cost
The psychological contract
Q Please tell me whether on the whole you agree or disagree with each of the
following statements?
% Agree
Britain’s National Health
Service is one of the best in
the world
The NHS will be there for me
when I need it
June 08
July 08
August 08
June 08
July 08
August 08
My local NHS helps improve
the health and wellbeing of
me and my family
June 08
July 08
August 08
% Disagree
57
61
63
27
22
24
74
18
77
14
82
9
68
73
73
Base: English adults aged 16+ (c. 900 per wave) N.B arrows represent significant differences in agreement from June-Aug 08
Source: Ipsos MORI NHS 60th awareness tracking August 2008
17
12
13
… and public want NHS protected
Which TWO or THREE, if any, of the following main areas of public
spending do you think should be protected from any cuts?
The NHS/health care
Schools
Care for the elderly
The Police
Social services
Defence
Benefit payments
Local authority services
Overseas aid
None of these
Don’t know
82%
58%
46%
35%
15%
13%
8%
6%
5%
*%
1%
Base: All who think some services should be protected (773), 19-21 June 2009
Source: Ipsos MORI Public Spending Index
Huge expectations pose real challenge to
the NHS…
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)
Which brings with it real risks…
Unrealistic public expectations likely to do
reputational damage to NHS – and undermine public
support
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….
Becoming a less compassionate society?
The state has a duty to
provide a decent standard of
living for the unemployed
85%
Government should
redistribute wealth to help
the poor
51%
38%
55%
1985
Now
Source: British Social Attitudes Survey 2010
1994
Now
Fewer now support extending 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?
% Government services such as health,
education and welfare should be
extended, even if it means some
increases in taxes
80
70
60
50
% 40
30
20
10
0
April '97
% Things should be
left as they are
% Taxes should be cut, even if it means
some reduction in government services,
such as health, education and welfare
% Don't
know
Tax increase/extend services
46%
33%
Things left as are
Tax cut/reduce services
Don’t know
November '00
Base: c.1,000 British Adults
April '05
18%
2%
June '09
Source: Ipsos MORI
So what do politicians
have to say?
A debate is needed…
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
Need to lead a fundamental debate with the
public and clinicians…
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…
Thank you – any questions?
For further information contact
jonathan.nicholls@ipsos.com
020 7347 3110
© 2010 Ipsos MORI – all rights reserved