With the papers full of stories about A&E this winter, and last week's Issues Index showing the NHS top of people concerns, it would be excusable to think that the public was full of doom and gloom about the NHS this winter. An Ipsos MORI poll in the Evening Standard showed a more nuanced picture.
We found that confidence in local NHS services in England has barely dipped since we looked at the question last in November 2014. Four in five (81%) had confidence in November that they would receive good care from local services, and in January this has remained roughly stable at 83%.
When you specifically reference the winter though, it seems there is concern. Asking English adults whether they think that local services are able to provide high quality care during the winter, seven in ten (70%) have confidence, around the same number as in November. However, the number who are not confident in local services during the winter has gone up from a quarter (25%) to nearly three in ten (29%). This is a small but important up tick, which demonstrates that the A&E strains have reached the public consciousness to some extent.
The yearly discourse of winter NHS strains has reached the public ear. What's more, people can distinguish between the NHS generally, which they know to offer the highest quality and the NHS in winter, where there is more concern. This is reinforced by the fact that those 'very confident' in local services drops from 33% in normal circumstances to just 18% when winter is mentioned.
Whilst the concern about the NHS during winter months is apparent, it is less obvious that this has turned to direct criticism. The public aren't laying the blame at the door of any particular group and blame things and circumstances before they blame individual people. When asked spontaneously to identify the causes of problems facing A&Es, the top issue is underfunding and cuts more generally (28%). Second on the list are people who use A&Es incorrectly (25%), whilst the third issue is strongly linked to the first: over-worked, underpaid NHS staff (24%).
Whilst a generic 'government' get some of the flack (12% blame government), specific groups within this are barely mentioned - the Conservative party get just 5% explicitly blaming them and 'the coalition government' have just 6% blaming them. These are not findings that suggest that the finger is immediately being pointed at specific groups at the top.
Other factors that people mention include immigration (9%) and the growing population (8%). NHS Managers and GPs receive a small portion of the blame too (12% and 10%, respectively). Overall, though, people aren't tossing up who to blame so much as what to blame.
We've found similar concerns when asking about public perceptions of the NHS for the Department of Health (last in 2013). People see the biggest problem facing the NHS to be the lack of resources (38%) as well as a lack of staff (27%), and these concerns have been present for many years. The NHS Tracker shows that people were concerned about the same things even during the Labour administrations. There has also consistently been a real concern that the NHS will face severe funding problems in the future, with the vast majority thinking this (88%).
This all suggests that concern about a winter crisis is compounding fears about underfunding more generally. Neither of the main parties has committed to providing the NHS with funding set out by the NHS Five Year Forward View and this suggests that funding concerns may remain an issue going into the next parliament. However, given that people are picking up on the winter strains narrative it is possible that the finger starts pointing at people rather than policies.
So, what should we use as our indicator of whether concern is turning into criticism? It won't be how much of a priority the NHS is to people, or how much they're thinking about it. Criticism happens when the concern lacks love and love for the NHS isn't showing signs of waning just yet. Since 2007, the NHS tracker has seen a steady increase in our pride that the NHS is one of the best health services in the world. In data published in January, we also saw a rise in people thinking that the NHS is a symbol of what is great in Britain. Whilst pride remains as high as it currently is, it's difficult to imagine the British people turning on its friend in need.