2019 was the second year in a row that Conservative Prime Ministers made significant announcements about NHS funding. Following Theresa May’s 70th birthday present to the NHS in 2018, Boris Johnson pledged an additional £3 billion capital investment plan to rebuild hospitals and replace diagnostic equipment.

This additional funding is of course very welcome within the NHS given recent low capital investment, although some previously promised capital funding has struggled to make it to the frontline.

This is a good political move on the Prime Minister’s part. We have frequently reported on the NHS as a national treasure (87% think the NHS is ‘a good thing’). While healthcare and the NHS are changing, the public has a deep connection to ‘hospitals’ as a symbol of the NHS and its ability to take care of us when we need it. This capital funding announcement really taps into those sentiments.

The announcement reflects the public’s wish for more funding for the NHS, with four in five thinking it is underfunded. After the Prime Minister’s first announcement of capital funding in August, 54% welcomed the money, but thought that more was needed, while 33% said the NHS requires a lot more money. Will the latest announcement, accompanied by photographs of Boris Johnson next to state-of-the-art scanners, be enough to swing voters towards thinking the Conservatives are investing enough in the NHS?

The focus on building hospitals reinforces traditional views of the NHS as associated with bricks and mortar and reflects current public opinion. For example, if the Government were to devote more funding to health and care services, the public’s top priority would be urgent and emergency care such as A&E and ambulance services (68%).

But if we want a financially sustainable and modern NHS, we need to change our relationship with it.
One area identified in future plans for the NHS is to encourage the provision of care outside of local hospitals – in the community or in more specialist centres. The public appear open to this approach, at least hypothetically. Eighty-six per cent say they would be prepared to travel further than their local hospital to a specialist centre for serious health issues. Some 67% of the public think they would receive the same standard of care in a local GP practice as in a hospital if they needed minor surgery. However, as anyone who has tried to move services out of local district hospitals knows, the hypothetical responses are very different to the emotional response from a community when they feel NHS bricks and mortar are threatened.

The health service also faces challenges in its perceived focus only on physical illness. Mental health is now one of the top public health concerns. Nearly all of us now think that mental and physical health are equally important (82%), yet only 20% think mental and physical health are currently treated equally in our healthcare system, and spending patterns reflect that. This dissonance is not only prevalent at a national policy level, but at an individual level. Although we claim that mental and physical health are equally important, 72% of us say we often think about our own physical wellbeing, but only 57% say we often think about our own mental wellbeing.

As the NHS faces increasing demand for mental health services and budgets continue to be strained, technology brings huge opportunities for the future around access to services. While new ways of interacting with healthcare professionals are seen as acceptable for some issues (for example, 63% say they would be willing to use a video consultation with their GP for advice on a minor ailment), this approach is less acceptable for others (acceptance falls to 55% for those seeking advice on an ongoing problem or condition). When thinking about how these technologies could ease the pressure on services, it is important to remember that millions of NHS users are excluded from online solutions.

While the Prime Minister’s funding announcements will certainly be welcomed and are a relief for those working within the NHS sites receiving funding, they do little to remodel the public’s relationship with the NHS. That is the big challenge for the 2020s – to build and accept a 21st century health service that relies less on local hospitals, treats mental and physical health equally, and makes use of new technology. Though I doubt the PM will mind if the public associate him with enhancing the bricks and mortar of the NHS.