Looking at a broad range of data, new health trends have emerged over the past seven decades leading to changing patient demands and fluctuating satisfaction levels with the NHS, notes Gillian Prior

This week the NHS turns 70, a milestone moment for the world’s largest single payer healthcare system. Throughout its existence it has been guided by the principle of availability to all, regardless of wealth.

Split views from beneficiaries

It is a sentiment that has been overwhelmingly supported by the British public, with two thirds of people consistently opposing the suggestion that “the NHS should be available only to those with lower incomes while firmly placing the responsibility of healthcare provision upon government”.

Health has always been top of the list of priorities for public spending and while attitudes towards the funding of the NHS have remained constant over time, levels of satisfaction have fluctuated; the lowest satisfaction level ever recorded by the British Social Attitudes Survey was 35 per cent in 1997 while in 2010, NHS satisfaction peaked at 70 per cent. It stood at 57 per cent in 2017.

The lowest satisfaction level ever recorded by the BSA was 35 per cent in 1997 while in 2010, NHS satisfaction peaked at 70 per cent

The most frequently cited reason for dissatisfaction is perhaps, unsurprisingly, waiting times, followed by staff shortages, lack of government funding and money wasted within the NHS.

In contrast, leading drivers for satisfaction are broadly tied to the performance of the NHS and include quality of care and attitudes and behaviour of staff.

Quantum leap over seven decades

Naturally, new health trends emerging in the past seven decades have led to changing patient demands. The last 70 years have seen significant increases in life expectancy, a clear indicator of the health of the population.

Office for National Statistics illustrates that a boy born between 1950-1952 could expect to live to age 66 compared with age 79 for a boy born between 2014-2016. Similarly for girls, life expectancy at birth has increased from 72 years between 1950-1952 to 83 years in 2014-2016.

Over 65s now make up around 18 per cent of the entire UK population, set to rise to almost 25 per cent by 2046. This increasing older population coupled with a growing dementia problem that sees 1 in 6 people over the age of 80 suffering from Alzheimer’s disease has fuelled rapid demand for social care.

The nation’s waists have also been growing: in 2016, 61 per cent of adults in England were overweight or obese, compared with 53 per cent in 1993.

Simultaneously, the rate of doctor diagnosed diabetes has increased from 2.4 per cent in 1994 to 6.9 per cent in 2016, leading to an increase of 56 per cent between 2005-06 and 2013-14 in the cost of medication and treatment for people with diabetes.

Radical reforms in mental health

Another topic that wasn’t at the forefront of the NHS’s agenda in its early stages but has gained prominence in recent years is mental health.

Measured in most detail by NHS Digital’s Adult Psychiatric Survey series, findings show a steady increase in the proportion of people with symptoms of Common Mental Disorders such as depression and anxiety.

In 2014, around one in six (17 per cent) adults surveyed had a CMD, up from one in seven (14 per cent) in 1993.

To cope with the expanding demand for mental health treatment, the NHS has implemented new services which integrate mental and physical treatments, as part of its Improving Access to Talking Therapies programme. Nevertheless, waiting times for specialist treatments and declining mental health staff numbers will continue to pose significant obstacles to meeting patients’ needs.

Addictions admonished

However, some changes in the nation’s health have been for the better. One of the biggest changes in health and lifestyles, measured in the Health Survey for England, has been the decrease in the proportion of adults who smoke, which fell from 29 per cent in 1996 to 18 per cent in 2016. In 1974, over 50 per cent of men in Britain were smokers.

At the same time, the proportion of adults who drank any alcohol in the past week decreased, from 67 per cent in 1998 to 58 per cent in 2016, and the proportion drinking above the current 14 units per week guideline has also been steadily decreasing.

Perhaps the biggest test for our society today is what Sir Michael Marmot, director of The UCL Institute of Health Equity and chair of the World Health Organisation’s Commission on Social Determinants of Health, has termed health inequities – “systematic inequalities in health between social groups that are judged to be avoidable by reasonable means”.

Social gradients

ONS’s figures show that in England, boys in the least deprived 10 per cent of areas at birth in 2014 to 2016 could expect to live almost a decade longer than those in the most deprived (9.3 years), while for girls the gap was 7.4 years.

The gap in healthy life expectancy at birth (the number of years lived in “very good” or “good” general health) exceeded 18 years for both men and women in England.

Reducing the gap in life expectancy and healthy life expectancy between the most and least deprived, will be the key challenge for the NHS in the next generation

The latest HSE shows many examples of social gradients in health and health related behaviours.

In the most deprived 25 per cent of areas, compared with the least deprived 25 per cent, women were more likely to be overweight and obese; men and women were less likely to meet the guidelines for physical activity; and people were more likely to be taking prescribed medicines. In the most deprived areas, men and women had lower well being scores, and were more likely to have probable mental ill health.

Tackling these social gradients in health and health related behaviours, and reducing the gap in life expectancy and healthy life expectancy between the most and least deprived in our society, will be the key challenge for policy makers and the NHS in the next generation.