Ben Page, Chief Executive at Ipsos MORI, speaking at the Future Challenges for the NHS conference at The King's Fund.

1. The NHS, the Election
and after…
Ben Page
Chief Executive
Ipsos MORI
Ben.page@ipsos.com

2. ..the public far less concerned about the NHS than
10 years ago
What do you see as the most/other important issues facing Britain
today?
Economy
70
60
50 Race/
immi-
gration
40
30 Crime/
Law &
20 Order
NHS
10
Unemployment
0
May May May May May May May May May May May May May May
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Base: representative sample of c.1,000 British adults age 18+ each Source: Ipsos MORI Issues Index
month, interviewed face-to-face in home

3. High satisfaction with NHS….
Overall, how satisfied or dissatisfied are you with the running of the National Health
Service nowadays?
Are you satisfied or dissatisfied with the way the Government is running the
country? 73
70
% Satisfied with current
running of NHS
60
50
40
30
25
20 % Satisfied with way government
is running the country
10
Dec-06
Jan-07
Feb-07
Mar-07
Apr-07
May-07
Jun-07
Jul-07
Aug-07
Sep-07
Oct-07
Nov-07
Dec-07
Jan-08
Feb-08
Mar-08
Apr-08
May-08
Jun-08
Jul-08
Aug-08
Sep-08
Oct-08
Nov-08
Dec-08
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)

4. The public still believe there is waste and
inefficiency in the NHS
Q Please tell me whether on the whole you agree or disagree with each of the following
statements:
% agree There is waste and
75
72 71 71 71 inefficiency in the NHS
69
65
59
55
51
The NHS provides good
53
49
value for money to
49 taxpayers
45
35
The NHS is getting better at
25 managing its budgets
19 21 22
19
17
15
A 8
Ju 8
D 7
D 8
M 8
S 7
O 7
Ja 7
S 8
O 8
8
N 7
N 8
M 8
Fe 8
08
A 7
A 8
-0
-0
-0
-0
-0
-0
-0
-0
-0
-0
-0
0
-0
-0
0
l-0
l-0
n-
n-
b-
ov
ov
ar
ay
ec
ec
pr
ug
ep
ug
ep
ct
ct
Ju
Ju
Base: 1,003 English adults aged 16+, December 2008 Source: Ipsos MORI/DH Perceptions of the NHS Tracker

5. Biggest Problems facing the NHS – top 5
Q What do you see as the biggest problems facing the NHS? What else?
%
50
45 Lack of resources/
investment
40
35
30 Bureaucracy/ top
heavy/ poor
management
25
Not enough
doctors/nurses/
20 understaffed
Long waiting
15 lists/times
Poor standards of
10 cleanliness/super-
bugs/ MRSA
5 * Please note that results
from March 2007 onwards
0 are not directly comparable
to previous data as the
Sep-04
Nov-04
Jan-05
Mar-05
May-05
Jul-05
Sep-05
Nov-05
Jan-06
Mar-06
May-06
Jul-06
Sep-06
Nov-06
Jan-07
Mar-07*
May-07
Jul-07
Sep-07
Nov-07
Jan-08
Mar-08
May-08
Jul-08
Sep-08
Nov-08
question was placed on
different studies
Base: English adults age 16+ (c.1,000 per wave) Source: Ipsos MORI/DH Perceptions of the NHS Tracker

6. Tories and Lib Dems were behind Labour on
healthcare
% who think issue is ‘very Conservatives Labour Lib Dems
important’ in helping them
decide how to vote
30%
Managing the economy 39 25%
12%
22%
Healthcare 20 37%
10%
27%
Education 17 29%
15%
22%
Unemployment 15 27%
11%
29%
Asylum/ immigration 13 15%
10%
25%
Taxation 10 23%
18%
Crime & anti-social 31%
behaviour 6 9%
20%
24%
Defence 6 21%
10%
Base: 1,003 British adults 18+, 25th-27th September 2009 Source: Ipsos MORI Political Monitor
NB. Figures exclude „don‟t know‟, „none‟ and „other‟ responses

7. But vastly ahead of where they were
I would like you to tell me whether you think the Conservative party, the Labour
party or the Liberal Democrats has the best policies on...
Major Blair elected Brown
as PM Labour leader 1997 as PM
(Nov 90) (Jun 94) ELECTION (Jun 07)
“Health Care”
“NHS” Cameron
elected
(Dec 05)
Labour
50 point gap
in mid 90s
Conservative
LibDem*
* Liberal in 1978, Liberal SDP Alliance 1983-7
Base: c. 1,000 – 2,000 GB adults aged 18+ Source: Ipsos MORI

8. MPs in different parties see NHS problems
very differently
What are the biggest problems facing the NHS?
% mentions (over 10%)
Lack of resources / investment 46 47
50
32
Ageing population 31 46
43
Bureaucracy 13 47
5
Public health problems 14 40
24
Government influence / targets 8 19
24
Not enough patient choice 4 11
Conservatives
16
Problems prioritising treatment 6 14 Lib Dems
14 Labour
Low quality treatment 8 13
88
Cost of care 13
Base: 121 candidate MPs (37 Conservative, 48 Labour, 36 Lib Dem), February-March 2010 Source: Ipsos MORI

9. Conservative agenda plays well to the crowd
Please tell me how strongly you support or oppose each of these possible
future changes for the National Health Service?
% Strongly support % Tend to support % Tend to oppose % Strongly oppose
More control over health services to be
given to doctors and nurses rather than 68 22 43
managers and politicians
Fewer national targets and more local
control 44 36 7 4
Reducing the number of managers in the
NHS by a third 49 26 8 6
Requiring patients to change their lifestyle
before they are allowed treatment 35 23 16 21
Publishing on the internet all NHS
spending over £1,000 20 21 21 18
Freezing pay of all those who work in the
NHS 11 11 27 39
Base: 1,006 British adults, 13-15 November 2009 Source: Ipsos MORI Public Spending Index

10. Coalition commitment
“We will guarantee that health
spending increases in real terms”

11. What do the public want? Everything!
Which of the following statements best reflects your thinking about the NHS?
%
90 The NHS is
crucial to
80 73
British society
73
70 and we must
72
do everything
60 to maintain it
50
All ABC1 C2DE The NHS was a
40 great project
30 27 but we
25 probably can‟t
20 23 maintain it in its
10 current form
0
2000
2001
Spring 2002
Winter 2002
Spring 2003
Winter 2003
Spring 2004
Winter 2004
Spring 2005
Winter 2005
Spring 2006
Winter 2006
2007 1st Qtr
Base: English adults age 16+ (c.1,000 per wave)

12. But expectations unrealistically high. People
want … … unlimited spending...
There should always be limits on what is spent on the NHS…
Don‟t know
8%
44% Agree
Disagree 48%
31% strongly disagree
with limits on NHS spending
Base: British public, 18+ (1,001) 12-17 January 2006

13. … and little concern about value for money
The NHS should provide the
most effective drugs and
treatments provided they
represent good value for
money
28% 31% The NHS should
provide all drugs
and treatments
no matter what
they cost
The NHS should
provide the most
effective drugs and 72% expect NHS to
treatments no matter 41% provide drugs no
what they cost matter what they cost
Base: British public, 18+ (1,001) 12-17 January 2006

14. The challenges

15. … growing realisation that spending cuts may
be necessary
There is a real need to cut spending on public services in order to pay off
the very high national debt we now have
60
55 Agree
54
% of respondents
51
50 48
44
45
45 Disagree
44
40 39
39
35
30
Jun-09 Nov-09 Mar-10 Apr-10
Base: c.1000 respondents aged 16+ in England and Wales.
Fieldwork dates: Jun 09 – April 10 Source: Ipsos MORI

16. But 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 82%
Schools 58%
Care for the elderly 46%
The Police 35%
Social services 15%
Defence 13%
Benefit payments 8%
Local authority services 6%
Overseas aid 5%
None of these *%
Don‟t know 1%
Base: All who think some services should be protected (773), 19-21 June 2009 Source: Ipsos MORI Public Spending Index

17. The public still believe that greater efficiency
can do it
Making public services more efficient can save enough money to pay off the
very high national debt we now have, without damaging services the public
receive
Strongly agree Tend to agree Neither agree nor disagree
Tend to disagree Strongly disagree Don't know
Nov „09 March „10
9%
2% 13% 4%
26%
35%
17%
14%
9% 6%
36% 29%
Net agree = +36 Net agree = +37
Base: 1,006 British adults, 13-15 November 2009 Base: 1,503 British adults 18+, 19th-22nd March 2010
Source: Ipsos MORI Political Monitor

18. Coalition commitments
“We will … incentivise ways of improving access to
primary care in disadvantaged areas”
“We will give every patient the power to choose any
healthcare provider that meets NHS standards
within NHS prices”
“We will publish detailed data about the
performance of healthcare providers online, so
everyone will know who is providing a good service
and who is falling behind”

19. Patients satisfied with ease of access to GP
%No % Yes
Are you satisfied with how easy it is to get
through to someone on the phone at your
GP's surgery?
13 87
In the last six months, have you tried to get
an appointment with a doctor fairly 23 77
quickly?
Were you able to get the appointment
on the same or on the next 2 days the 13 87
surgery was open?
In the last 6 months have you wanted
to book ahead for an appointment with 42 58
a doctor?
Last time you wanted to, were you able
to get an appointment with a doctor more
23 77
than 2 full days in advance?
Base: 1 (1,351,886); 2 (1,012,334); 3 (1,329,542); 4 (1,317,279) 5 (747,599) Source: Ipsos MORI/DH GPPS 2008

20. Patients also satisfied with booking GP
appointments
%No % Yes
In the last six months, have you
ever wanted to make an
appointment with a particular 37 63
doctor at your GP surgery?
Last time you wanted to, were you able to
make an appointment with a particular 12 88
doctor - even if it meant waiting longer?
Over the last 6 months or so, were
you satisfied with the hours your 18 82
GP surgery was open?
Base: 1 (1,317,793); 2 (822,473); 3 (1,946,018) Source: Ipsos MORI/DH GPPS 2008

21. Majority of inpatients/outpatients satisfied
with waiting times
How satisfied or dissatisfied were you with how long you had to wait from the
time your GP referred you to a hospital to when you actually saw the hospital
specialist?
Don‟t know / not stated (2%) I do not have an appt date yet
Not at all satisfied 4%
7%
Not very satisfied 11%
41% Very satisfied
Fairly satisfied 35%
Base: 93,217 English inpatients/outpatients, March-May 2009
Source: Ipsos MORI / DH National Patient Choice Survey

22. Increasing awareness
of choice

23. The public are increasingly aware of choice
inside and outside the NHS
Please tell me whether on the whole you agree or disagree with each of the following
statements:
% agree
90 Nowadays you can get a
wide range of treatment
and care outside
80 hospital
75
70
60 59
People have
50 increasing choice
about their treatment
and care
40
30
Jul-07
Aug-07
Sep-07
Oct-07
Nov-07
Dec-07
Jan-08
Feb-08
Mar-08
Apr-08
May-08
Jun-08
Jul-08
Aug-08
Sep-08
Oct-08
Nov-08
Dec-08
Base: 1,006 English adults aged 16+, March 2010
*statement not asked in Dec 08, March 09, June 09 Source: Ipsos MORI/DH Perceptions of the NHS Tracker

24. Coalition commitment
“We will strengthen the power of GPs … by enabling
them to commission care”

25. Support for PBC among GPs
In general, to what extent do you support or oppose Practice Based
Commissioning (PBC) as a policy?
Support Oppose
70
62 64 62 64 63 64
60 59
57
50
40
%
30
20 20
17 17 15 15 15
14 13
10
0
Wave 1 Wave 2 Wave 3 Wave 4 Wave 5 Wave 6 Wave 7 Wave 8
Base: Wave 8: 1,698 practices (3 June – 28 August 2009); Wave 7: 1,797 practices (3 April - 5 June 2009); Wave 6: 1,898 practices
(1 December 2008 - 27 February 2009); Wave 5: 1,833 practices (19 September - 16 November 2008); Wave 4: 1,891 practices (2
June - 5 August 2008); Wave 3: 1,988 practices (15 Jan - 7 March 2008); Wave 2: 1,398 practices (10 Sept - 23 Nov 2007) and
Wave 1: 1,198 practices (18 June - 06 Aug 2007)

26. Has PBC improved patient care acc to
GPs??
To what extent do you agree or disagree that PBC has improved patient care?
Agree Disagree Too early to tell
50
46
40
37 36 37
31 31 31 32
30 30 29 29 29 30
27 27
%
22
20 19
18 18
16
13 12 13
10
0
Wave 1 Wave 2 Wave 3 Wave 4 Wave 5 Wave 6 Wave 7 Wave 8
Base: Wave 8: 1,698 practices (3 June – 28 August 2009); Wave 7: 1,797practices (3 April - 5 June 2009; Wave 6: 1,898 practices
(1 December 2008 - 27 February 2009); Wave 5: 1,833 practices (19 September - 16 November 2008); Wave 4: 1,891 practices (2
June - 5 August 2008); Wave 3: 1,988 practices (15 Jan - 7 March 2008); Wave 2: 1,398 practices (10 Sept - 23 Nov 2007) and
Wave 1: 1,198 practices (18 June - 06 Aug 2007)

27. New services
How many new services, if any, has your practice or PBC group commissioned
as a direct result of PBC?
Any new services No new services
100
90
80
70
61 62 64
60 60 59 56
% 50 52 49
46
40 41
33 36
30 32 29 26 25
20
10 NB wording change Wave 4 to Wave 5
… your practice… …your PBC group …
0
Wave 1 Wave 2 Wave 3 Wave 4 Wave 5 Wave 6 Wave 7 Wave 8
Base: Wave 8: 1,698 practices (3 June – 28 August 2009); Wave 7: 1,797 practices (3 April 5 - June 2009; Wave 6: 1,898 practices
(1 December 2008 - 27 February 2009); Wave 5: 1,833 practices (19 September - 16 November 2008); Wave 4: 1,891 practices (2
June - 5 August 2008); Wave 3: 1,988 practices (15 Jan - 7 March 2008); Wave 2: 1,398 practices (10 Sept - 23 Nov 2007) and
Wave 1: 1,198 practices (18 June - 06 Aug 2007)

28. PCT management support for PBC
How would you rate the quality of managerial support for PBC provided by your
PCT?
Good Poor
60
50 51 50
49 49 48 49 48
46
44
40 42 41 43
40 40 39
37
%30
20
10
0
Wave 1 Wave 2 Wave 3 Wave 4 Wave 5 Wave 6 Wave 7 Wave 8
Base: Wave 8: 1,698 practices (3 June – 28 August 2009); Wave 7: 1,797 practices (3 April - 5 June 2009; Wave 6: 1,898 practices
(1 December 2008 - 27 February 2009); Wave 5: 1,833 practices (19 September - 16 November 2008); Wave 4: 1,891 practices (2
June - 5 August 2008); Wave 3: 1,988 practices (15 Jan - 7 March 2008); Wave 2: 1,398 practices (10 Sept - 23 Nov 2007) and
Wave 1: 1,198 practices (18 June - 06 Aug 2007)

29. Coalition commitments
“We will ensure there is a stronger voice for
patients locally through directly elected individuals
on the boards of their local PCT”
“The local PCT will act as champion for patients”

30. The public say they want to be consulted
And thinking of how decisions about treatments and services should be made,
which of these statements most closely matches your opinion?
Don‟t know Decisions about which
NHS treatments and
The general public should 5% services are available
should be made solely
be much more actively 20% by qualified health
involved in shaping which professionals and not
NHS treatments and 20%
the general public.
services are available e.g.
deciding local priorities and
allocating budgets.
The public should be
consulted on decisions
shaping which NHS
treatments and services
should be available but
54% the final decisions should
be made by qualified
health professionals
Base: 988 English adults (18+), November 2008 Source: Ipsos MORI/Social Market Foundation

31. Most want standard treatment available
across the country
And thinking of the treatments that are available on the NHS, which of these
statements most closely matches your opinion?
Don‟t know The availability of
NHS treatments
4% should be based
23% on local need
Treatments should rather than a
only be available on ‘one size fits all’
the NHS if they are approach across
available to
everyone and not the country.
dependent on where
you live
73%
Base: 988 English adults (18+), November 2008 Source: Ipsos MORI/Social Market Foundation

32. On balance, public support for prioritising services
How should NHS budget shortfalls be addressed?
Don‟t know Taxation should
increase
10%
18%
NHS should 29% 13% Individuals should
prioritise contribute
30%
Government should prioritise
Base: 988 English adults (18+), November 2008 Source: Ipsos MORI/Social Market Foundation

33. Big support for getting involved – though in
practice…
In principle, would you support or oppose extending Community Partnerships to
other parts of the Borough?
And would you personally be interested in getting involved?
Support Involvement
Don’t know/no Don’t know
opinion
Depends 2%
No, oppose
12% Yes
18% 26%
6%
Yes,
support
82%
54%
No
Base: All residents (1,021) Base: All resps who support the idea (835)

34. Three key questions
 Should NHS be based on national standards or local need?
 everyone driven by “fairness” – but different interpretations
 ¾ say national standards – yet propose local variation
 the meaning of “postcode lottery” more subtle than appears
 How do the public want to address the spending gap?
 most people say “prioritisation” – but means different things
 for some, based on clinical assessment of where money best spent
 for others, it‟s about focusing on more large scale interventions
 Do the public want to be more involved in decision making?
 in principle yes, but unlikely in practice
 not a hunger to be consulted on everything
– focus should be on wide reach services needing public buy in
 if there is objective, clinical evidence, public happy not to be engaged
 concerns it will let in subjectivity and vested interests – less “fair”
Source: Ipsos MORI/Social Market Foundation

35. Coalition commitment
“We will give front-line staff more control of their
working environment”

36. Getting staff on board key – staff bad mouthing
one of the key drivers of patient dissatisfaction
Greatest drivers of Personal experience of
overall satisfaction NHS services
Support for
Government
Believe NHS is
changing
Feel safe in NHS care
Staff bad-mouthing
Weaker drivers
of overall National newspaper
satisfaction coverage
Mis-management/
bureaucracy in NHS
Perceptions of social
care
Gender, age, region

37. In recent years, the NHS had some of the highest
levels of negative staff advocacy in the public sector
Critical Favourable
-3 Doctors 70% 3%
-2 GPs 71% 7%
-13 47% 15%
Practice nurses
New Hospital nurses 42% 10%
-37 New NHS senior clinical managers 40% 23%
NB. NHS managers net % change shows the difference between general managers (Aug 06) and senior clinical
managers (Dec 06). Drs = both groups, GPs = both groups

38. All your powers of leadership
and persuasion will be tested

39. Good leaders engage their staff
% Agreeing that Factor is being delivered
56%
I understand my role 52%
and how it fits into 47% Healthcare Commission
the bigger picture 34% quality Rating
Excellent
38%
Senior managers care Good
35%
about me and my work Fair
32%
28% Weak
59%
I am able to realise 54%
my potential 53%
43%
Base: 37 NHS Trusts, August 2007

40. Thank
you
Ben.page@ipsos.com