A vote on NHS reform and the funding squeeze?
Fieldwork for the British Social Attitudes survey took place from 4 July to 10 November 2011. This followed a sustained period of negative media coverage driven by concerns about the Health and Social Care Bill.
These concerns culminated in a pause in the Bill’s parliamentary passage and the NHS Future Forum's report in June 2011, which led to significant amendments being made to it (NHS Future Forum 2011). During the period the interviews were carried out, the BMA stepped up their campaign against the reforms and a number of high-profile peers voiced concerns when the Bill reached the House of Lords in September.
At the same time, in order to make the case for the reforms, the government focused on how the NHS needed to improve, arguing that it performs badly on key outcomes such as cancer survival rates compared to health systems in other countries. This was accompanied by strong ministerial rhetoric about ‘bureaucracy’ and the need to cut the number of NHS managers.
Although some months after the British Social Attitudes survey fieldwork in 2011, a poll by YouGov in February 2012 indicated that around 48 per cent of those surveyed opposed the government's reforms while 18 per cent supported them (YouGov 2012b). Support for the reforms was, at 45 per cent, not particularly high among Conservative supporters, and among Liberal Democrat supporters fairly low at just 17 per cent (with 49 per cent opposed). Across the whole poll there were a large proportion of 'don't knows' (34 per cent) – including Conservative and Liberal Democrats (37 and 34 per cent respectively).
Opposition to the government’s NHS reform plans for England and the sometimes less-than-positive rhetoric from ministers to justify their plans may in part at least have influenced the reduced satisfaction with the NHS.
Satisfaction with the NHS overall by country
A partial counter to this is the fact that satisfaction with the NHS also fell significantly in Scotland and Wales (see the graph above). This does not necessarily mean that views about the English NHS reforms did not influence (English respondents') satisfaction rates; other factors may have been at play in Wales and Scotland (funding, for example, which in both countries reduced in real terms between 2010/11 and 2011/12 ). However, there may also have been a 'spill over' effect in Scotland and Wales, with the debate about the English reform proposals having a (negative) impact in these countries too.
At the same time, the media also carried a number of stories about performance and financial pressures associated with the financial squeeze. The year 2011 was the first following the 2010 spending review which, in England, provided for a near real terms freeze in health spending and, as noted, real cuts in Scotland and Wales. Associated with the settlement in England in particular, was a high-profile policy to improve productivity (generally, though not exclusively, through cost reduction). The extent to which the public understood that the £20 billion productivity improvement programme was simply a cut in services and quality is unknown.
However, it seems likely that regardless of its impact within the NHS, the public will have viewed the productivity improvement programme as a sign of the NHS being under pressure financially and this may well have affected their level of satisfaction with it.
Possible explanations for the fall in satisfaction - other data in this section
- Figure 5 - a comparison of the BSA results with Ipsos MORI's regular issues survey
- Figure 6 - how perceptions of quality compare between people who've had recent personal contact with outpatients' services, and those who haven't
- Figure 7 - a view of satisfaction with the NHS overall by party identification