Institutional trust and NHS reform

Professor Peter Taylor-Gooby (p.f.taylor-gooby@kent.ac.uk)
Dr Andrew Wallace (a.wallace@kent.ac.uk)
SSPSSR, University of Kent

Summary of the research project

We carried out 48 interviews in London and the South East.  The sample was split to give an even balance of gender, age group and location. All interviews were transcribed with the names anonymised, and the data then analyzed and written up.  We have so far disseminated the findings in two journal papers and they have been discussed on BBC Kent radio and Radio Invicta 

The findings

Attitudes towards the NHS
• The majority support the ‘traditional’ NHS values of universal access, free at the point of use, run by the state
• Some believe this model is outdated in the modern world and cannot meet everyone’s needs satisfactorily given the extra pressures on from medical advances and an ageing population 
• However, no desire to see the NHS dismantled; widespread pride in the NHS.  It is considered better than systems in the USA and other countries
• Nonetheless, a strong sense that the NHS is underperforming and failing to meet public expectations

Problems identified in the NHS
• Operational problems like ‘superbugs’ and inadequate facilities
• Widespread perception that money is not spent effectively, and that too little goes to patient care
• A strong feeling from many people that the NHS is top-heavy with managers and other bureaucrats
• A sense that a combination of targets and red tape is constraining the ability of frontline staff to provide good patient care

Feelings about the reforms of the NHS 
• Limited awareness and understanding of reforms on the part of most interviewees
• Little support for a market within the NHS where hospitals and clinics compete for patients
• However, support from some of those interviewed for the NHS to be more business-oriented and efficient
• Widespread unease about greater private sector involvement in the NHS; worries about profits being put before patients
• Targets seen as an ineffective or, at worst, damaging way to manage performance
• Mixed reaction to greater patient choice. Some in favour, some against, with the majority in the middle unsure how to handle choice or make informed choices. Many do not perceive choice to be a reality in their area and believe it will overload some hospitals and force some groups to rely on poorer facilities
• No evidence of public support for the current reform approach to the NHS. Indeed, most people think current reforms could damage the NHS further and lessen its ability to deliver care to patients and ensure they are treated with proper respect.

We would like to thank you again for your participation in this project. A fuller summary of the research findings is available on request at the above email addresses