Ruth Robertson: The British Social Attitudes Survey - public perception of the NHS

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  • Posted:Thursday 21 April 2016

Ruth Robertson discusses findings from the latest British Social Attitudes survey and how this information can be used to improve services.

This presentation was filmed at our event, How to use patient feedback more effectively to improve services, on 21 April 2016.


Well, every year when we receive this status that John and I, there’s one headline indicator that we always look at first, and that’s the question that’s asking people about their overall satisfaction with the NHS. We ask them all in all how satisfied or dissatisfied are you with the way the NHS is run nowadays, and we’ve got data going back to 1983 on this measure which I’ll show you in sort of three stages.

If you focus on the black line which is very and quite satisfied, you can see it’s sort of fluctuated up to 2001. The really bad years for the NHS were… if we look in 1996 and 1997, half of the British public were dissatisfied with the Health Service – so really high levels of dissatisfaction, and even in 2001 at the end of this series, just 38% of the population were telling us they were satisfied.

But then we saw a change. The next decade saw rapid rises in satisfaction – up to 70% in 2010 – the highest rate by far in the survey’s history, and I think it’s probably no coincidence that those ten years coincided with really rapid funding growth in the NHS. Nett expenditure doubled over that time period, and the improvements that that brought to waiting times in NHS premises I think will have had a big impact on satisfaction rates.

I think we all know what happened in 20101. Things changed. Funding growth slowed in the NHS and we started to see implementation of a big programme of reforms following the Health and Social Care Act in 2012. So what was the impact of that on satisfaction? Well in the first year, so in 2011, there’s actually a really big drop – a 12% drop in satisfaction down to 58%. It’s the biggest one year drop we’d seen in the survey’s history, and at that time, we thought this was maybe the start of a really steep downward trend back to the levels we saw in the 80s and the 90s. But actually that isn’t what’s happened, it’s really levelled off since then, and it’s quite a positive story for the NHS because satisfaction is still very high by historic standards.

In 2015, for the first time, we added a follow up question – you told us you were satisfied or dissatisfied, can you tell us why? And this is what people said. So this is the 60% of people who told us they were satisfied in 2015. They could pick up to three reasons to explain that reason and the most frequent response was, “I’m satisfied because of the quality of race in the NHS,” and we don't know if that’s about their own experience using the service, family or friends experience or stuff they’ve read in the papers about quality but this general perception that it’s high quality care is behind that satisfaction.

The next two factors I think are more about some of the founding principles of the NHS. So 59% told us it’s because the NHS is free at the point of use, and 54% told us it’s because of the real comprehensive range of services available in the NHS. Then attitudes and behaviour of NHS staff also a big factor, and about a third of people said it was about short waiting times.

I think perhaps even more interesting is looking at the reason why people were dissatisfied because perhaps then we can address the problems in the NHS. So here’s 23% of people – so I guess if you think about where we’re sat now, we’re probably one person on every row in this room would say they were dissatisfied with the NHS, and these are the reasons that they told… used to explain that. Number one reason is waiting times – waiting times for either a GP or hospital appointment, and that’s perhaps no surprise. But then the next three reasons are actually all about resourcing – so there’s not enough staff in the NHS, the government doesn’t spend enough money and money is wasted.

So three factors about resourcing. We have to go down to the fifth most popular factor, just a quarter of people said it was about quality of care. So actually, this measure of dissatisfaction is not really telling us that there’s necessarily a quality problem in the NHS – it’s picking up something else about access and resourcing.


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