If the NHS is in crisis, why is public satisfaction so high?

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Part of Public satisfaction with the NHS

The British Social Attitudes (BSA) survey provides a fascinating view of public attitudes to the NHS stretching back to the early 1980s. We have just published findings from the latest survey, conducted by NatCen Social Research between July and October 2016 across England, Scotland and Wales. The results may be surprising to some, given the current pressures on the health and care system.

In 2016, public satisfaction with the NHS was 63 per cent, which is high by historic standards. Satisfaction is broadly the same as it was in 2015 – the small increase (up from 60 per cent) is not statistically significant. The chart below shows that in recent years, satisfaction can broadly be split into three phases: ‘steady growth’ from 2002 to 2010, ‘a sudden drop’ in 2011 and ‘little change’ from 2012 to 2016, when (with the exception of 2014) annual changes in satisfaction have not been statistically significant.

How do we square this picture of high satisfaction, broadly unchanged from a year earlier, with what researchers (including me), the media and some politicians have been saying about a growing crisis in the NHS? Here are a few possible explanations.

First, this is a survey of public perceptions rather than patient experience. Many of the respondents won’t – for example – have used hospital services in the past year (although most are likely to have used GP services, or at least know family members or friends who have), and their responses are influenced by a range of factors. To explore what lies behind public satisfaction with the NHS, we added a follow-up question to the survey asking people who were satisfied to tell us why. The most popular reasons were the quality of care, the fact the NHS is free at the point of use, and the range of services available. This tells us that this is not a straightforward measure of NHS performance: people may be signalling their support for the NHS as an institution, as well as commenting on the quality of service it provides.

Second, this survey is conducted over the summer and autumn, so the 2016 results do not pick up how extra pressure on the NHS this winter might have affected public views. However, declines in performance up to autumn 2016 (such as A&E performance well below target, and high bed- occupancy levels) do not seem to have dented public satisfaction. This may be because some commonly used services, like hip replacement surgery, have seen relatively small reductions in performance that may not have affected experiences enough to have changed public views (for example the average wait for trauma and orthopaedics patients was one week longer in October 2016 than it was a year earlier).

Third, the worst pressures on the health system are experienced by only a very small proportion of the population. For example, in 2016, long waits in A&E were more frequent than in previous years, but only around five per cent of people in England spent more than four hours in A&E, and because some people attended A&E on multiple occasions, the true figure is likely much lower. Although waiting times for routine treatment are rising, only around one in ten patients wait longer than 18 weeks from referral to treatment. Even in general practice, where we know high demand has contributed to difficulties getting an appointment, only 12 per cent of patients describe their overall experience of making an appointment as negative.

Despite years of financial pressure, most patients are seen in A&E within four hours, most people wait less than 18 weeks for elective care and most people can get a GP appointment when they need it. Overall the NHS continues to provide a good service to most patients and the high levels of NHS satisfaction in the BSA are likely to reflect this.

It may also be that people have become used to headlines about an ‘NHS in crisis’ and that satisfaction levels – which have hovered around 60 per cent for the past five years (with the exception of 2014) – incorporate this. Indeed, a recent survey from Ipsos MORI found that people living in Great Britain are more positive about the quality of their health care than people from most of the other 23 countries included in the study.

While the NHS is currently going through a difficult period, in which a lack of funding has led to targets being missed and deficits, I take this year’s results as a clear signal that the public has high regard for a publicly funded, comprehensive NHS and most people living in Great Britain remain happy with the service. This is an important message to policy-makers thinking about how the service might change in the future.

Looking back at the satisfaction results over 34 years, the rise in satisfaction levels between 2002 and 2010 also highlights the valuable legacy created by investment in the health service during that period, which turned around decades of poor results. The BSA enables us to see the broad impact of health system improvements over decades and it is this long-term view that makes this such a valuable (though complex) measure of public views.

Comments

Stevie Gee

Position
Consultant,
Organisation
NHS hospital
Comment date
30 March 2017
The people of the UK have Stockholm syndrome. They do not realise how bad care is when compared to other comparable countries even when the data are shouted from the rooftops.

All they care about is that the NHS is 'free'. It isn't and standards are appalling. Everyone who can afford it and wants to look after their family should now get private healthcare. We are at that point now.

John Wardman

Position
retired,
Comment date
31 March 2017
It is a disgrace your organisation approves of the STP. You should be ashamed of yourselves. Watch the news this weekend as 14 communities across Devon put redlines round their hospital to show they will not stand for any cuts to any health services in our county!

Kassander

Position
Independent Volunteer,
Comment date
31 March 2017
I often puzzle at how many who praise 'private' provision in education, health services, etc and denigrate those which are free @ the point of need are also those who have been educated and trained via those public services. During those periods as students, they have benefited from the free use of bodies and brains on which to practice. Perhaps like their places of education we patients should now start charging for our services?
So many of these supporters of the 'private' domain are however more than content to earn their (main) income from that selfsame despised public service.
Is this altruism writ large or Cognitive Dissonance?

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