Why has satisfaction fallen between 2010 and 2011?

For all services apart from dentistry and for the NHS overall, satisfaction fell. Why might this have happened and what might it indicate about the quality of NHS services as perceived by the public?

Latest public satisfaction survey

View the most recent results: British Social Attitudes survey 2015.

There are a number of possible explanations that we have examined in turn, and, where possible, attempted to triangulate results with other surveys and data sources.

Expectations have increased

Satisfaction is a relative concept that may change as the public's expectations of the NHS change. If expectations of what constitutes a good service increase, satisfaction may decline if the NHS fails to keep pace with such changes.

It is generally presumed that, over time, what the public expects in terms of the quality of service – not just from the NHS, but from public services more generally – has been increasing. If this is the case, then a fall in satisfaction may be, in part, the result of the NHS failing to keep up with expectations (rather than a fall in the quality of services). However, while there is no evidence either way, it is improbable that the public’s expectations of the NHS would increase to the extent that would be necessary, and over just one year, to account for the 12 percentage point drop in satisfaction with the NHS overall.

An actual or perceived reduction in the quality of NHS services and the NHS overall

Respondents to the survey may be reacting to actual deteriorations in aspects of the NHS which they value and so express less satisfaction. Alternatively, and for whatever reason, respondents may perceive a reduction in the performance and quality of the NHS – for example, through negative media stories and reporting – and express this as a reduction in satisfaction.

Is there evidence for an actual reduction in quality? See Figure 5 for a comparison of the BSA results with Ipsos MORI's regular issues survey

See Figure 6 for a graph of how perceptions of quality compare between people who've had recent personal contact with outpatient services and those who haven't

A 'surrogate' vote

A further explanation may be that respondents to the survey have expressed greater dissatisfaction with the NHS as a surrogate for dissatisfaction with other things – for example, with the government and its policies in general (rather than the NHS in particular).

See Figure 7 for a view of satisfaction with the NHS by political party identification

See Figure 8 for a view of satisfaction with the NHS by country

Technical/statistical factors

As with any survey, the ordering of questions, the size of the sample and so on may affect the responses received. Changes in these and other factors from one year’s survey to another may account for some of the difference in results.

The British Social Attitudes survey is seen as a 'gold standard' methodologically. Nevertheless, surveys are based on samples and so results will always be subject to some uncertainty. In addition, differences between years in, for example, the ordering of questions may affect responses.

In 2011 the health care questions were asked of a third of respondents (1,096), whereas in previous years they were asked of two-thirds or the full sample (which equates roughly to 2,200 and 3,300 respondents respectively). Thus the margin of error associated with the results obtained in 2011 is higher, at +/- 3 to 5 percentage points, compared with around +/- 1 to 2 points in previous years. Nevertheless, even at the extremes of this margin, the satisfaction results for the NHS overall, for example, remain statistically significantly different from those in 2010.

In terms of any 'ordering effects' these are not thought by the survey designers to apply in this case – questions about satisfaction with the NHS are always asked in the same order during the face-to-face interviews and no impact on the results is believed to arise from slight changes to preceding topics asked as part of the wider survey.