Public satisfaction with the NHS falls to a 25-year low

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The latest British Social Attitudes (BSA) survey reveals that public satisfaction with the NHS fell by 17 percentage points between 2020 and 2021. Overall satisfaction with the NHS is now at 36 per cent, down 17 percentage points from 2020, the lowest level recorded since 1997 and the largest year-on-year drop in the history of the BSA survey. 

This dramatic fall in satisfaction is mirrored across all NHS services – from inpatients and outpatients to accident and emergency, as well as general practice and dentistry – and across nearly all demographic groups.

Figure 1: Public satisfaction with the NHS, 1983 to 2021

The survey, carried out in early autumn 2021, coincided with an extraordinary time. Covid-19 had had a terrible impact on people’s lives and the economy, and had severely tested the resilience of the NHS. The need to prioritise the treatment of patients with Covid-19, to set up services that limited the risk of infection and to then deliver the largest vaccine programme in the country’s history meant that the NHS had had to deprioritise care and treatment in other areas. And all this when the service was already under considerable strain: there were large numbers of staff vacancies and millions of people on waiting lists for treatment before the pandemic took hold. The public were asked to play their part in this collective endeavour and ‘Protect the NHS’. And they did.   

There were large numbers of staff vacancies and millions of people on waiting lists for treatment before the pandemic took hold.

As the pandemic began, people largely accepted the need to change to different ways of accessing care and for the most part accepted delays in referrals and treatment. We know from the GP Patient Survey, conducted in early 2021, that large numbers of people avoided making GP appointments in the first year of the pandemic so they would not be a burden on the NHS. ‘Clap for carers’ showed the huge amount of goodwill there was towards the NHS and its staff in the early stages of the pandemic.   

Polling by YouGov suggests a ‘halo effect’ around the NHS in the first year of the pandemic and that high levels of satisfaction were as much a measure of support for the NHS and its staff as a reflection on the services provided. However, as the pandemic wore on, this appears to change. Public attitudes research by BritainThinks in May and June 2021 concluded that ‘for the first time in this programme of work, there are indications that the Covid-19 “grace period” is coming to an end.’   

By the time respondents were completing the 2021 BSA survey in mid-September 2021, key aspects of NHS performance were continuing to deteriorate. There were nearly 6 million people on waiting lists in England up from 4.4 million before the pandemic hit. There was a debate raging in the media around access to general practice and particularly about face-to-face appointments. It is important to remember that, behind the numbers and headlines, there are people who are living with pain and anxiety because they are unable to get the care they need and families who are worrying as their loved ones wait for treatment. 

The public recognise the challenges Covid-19 has placed on the NHS and particularly its staff but the public’s increasing frustration with their own experiences of accessing health care is clearly evident when asked, as part of the BSA survey, what the NHS should prioritise. The answers were: make it easier to get a GP appointment (48 per cent), improve waiting times for planned operations (47 per cent) and increase the number of staff in the NHS (47 per cent). It is hard to see how the NHS can deliver the first two priorities if it does not have the staff to do so – something the public have recognised for some time now. And it’s hard to improve staffing without adequate funding. Again, the public recognises this, with 8 in 10 agreeing the NHS has a ‘major’ or ‘severe’ funding problem. 

Pretending the NHS will get back on an even keel any time soon is unrealistic and will only serve to increase expectations that cannot be met.

Addressing these priorities will no doubt lead to an improvement in overall satisfaction with the NHS but it will take time as the NHS and its workforce recover from the pandemic and everything it is has brought. Pretending the NHS will get back on an even keel any time soon is unrealistic and will only serve to increase expectations that cannot be met. Expectations that are likely to be raised further when taxpayers start paying the new Health and Social Care Levy on 6 April 2022.   

So far, the government and the NHS have recognised this and have been open in emphasising that hospital waiting times are likely to get worse before they get better. But as the BSA survey has shown, dissatisfaction stretches across all NHS services – not just hospital care – and includes general practice and dentistry. Fixing hospital waiting lists is only part of the problem. The government and the NHS need to communicate clearly with the public about the steps they are taking to improve services, what people can expect and when, and resist the temptation to descend into a blame game as public concern and political pressures increase.   

Although these survey results seem very gloomy for the NHS, the public’s faith in the core principles of the service does not appear to have been eroded. The overwhelming majority of respondents in 2021 agreed that the founding principles of the NHS ‘definitely’ or ‘probably’ apply: that the NHS should be free of charge when needed (94 per cent), that the NHS should primarily be funded through taxes (86 per cent) and that care should be available to everyone (84 per cent).   

It would seem that the public do not want a radical overhaul of the NHS, rather a health service that is appropriately funded and staffed to deliver the quality of care they need.    


Susan Elliott

Retired NHS Acute care nurse practitioner/ clinical lecturer,
Comment date
08 April 2022

"It would seem that the public do not want a radical overhaul of the NHS, rather a health service that is appropriately funded and staffed to deliver the quality of care they need"

This is opinion. Joe public generally does not have access to the data required, nor the analytical skills to make an informed decision regarding NHS funding, nor how improved funding would produce improved quality of care
This summary focuses on access and waiting list times.
Based on my ex professional opinion and the 6 emergency hospital admissions of my elderly parents in the last 2 years, the quality of care is inadequate,and whilst some of the reason may be due to staffing shortages, there are also other reasons which aren't related to numbers of staff
Generally , staff lack any sense of urgency.
Communication with patients and family / carers is very poor
Assessment of elderly people with pre existing disabilities , including dementia ,is appalling , leading to omissions of important care
D2A is leading to unsafe transfer of care to inappropriate settings ( eg residential homes) before a full nursing and therapy assessment and care plan is in place .
In turn this is increasing readmissions and placibg ever increasing pressure on Social care who appear poorly equipped to care for people with complex care needs.
I would suggest that the D2A policy during the pandemic , rather than just COVID infection itself, has lead to a huge number of deaths of elderly people.

They aren't following local or national evidence based guidelines or using frameworks to deliver organised, efficient and effective care, eg the nursing process- Assess, Plan, Implement, Evaluate . It's not rocket science.

However, my overall feeling regarding the NHS nowadays is that staff don't " care" and this is demonstrated in their attitudes and the lack of commitment to providing the best quality care that they are able.

Barrie french

Member of the public
Comment date
01 April 2022

I had tried to form a a PPG in my westlancashire CCG the CCG informed me that this was not a path they would be taking. They have since given all our primary care to there private provider virgincare [ not the GP practice] they pay virgincare for all the services on invoices with the wording virgincare ltd, when I asked on a FOI if they show what each services cost they informed me it’s easier not to separate so all the services which include walk-in centres, district nurse, hub , call out centres,clinical assessment service short intensive support service so we have no idea what the costing are to virgincare.there is no accountability and and it seems they are not accountable to anybody.the external auditor informed the CCG that one service the short intensive support service was not VFM it had poor accountability and planning informed the Secretary of State gave them a section 30 and a red flag[I have copy’s of the auditor comments,the CCG has removed them from the auditor comments.what is clear to me is that mangers in the CCG are trying there best to carry out privatisation why being payed by the taxpayers.
I am 77 and have been asking questions since 2018 the other who tried to form a PPG have since left on our treatment in meeting they just ignored us.but have threatened me with legal action if I carry on asking questions but is them that are misleading me on FOI reply’s .it’s no wonder private providers are receiving more work as the NHS no accountability policy in place and when private providers know this it makes it very easy for them.
I can confirm all my concerns on the CCG FOI reply’s.

Michael Burt

X councillor,
Parish Council
Comment date
01 April 2022

The Problem with the health service is the the government want to privatise it and adopt the American insurance system, they are already diverting Public money to their mates to carry out tasks which could be performed cheaper by the NHS, if it had the resources.
The Covid pandemic should have been covered if the NHS staffing and facilities had been maintained at the correct level. But the Government want to create a situation where the public is dissatisfied with the NHS, because that suits their aim. I was on crutches for 3 months due to a telephone diagnosis that it was Arthritis,when eventually it was a fractured femur, of course I am dissatisfied, Not with the NHS but the private Doctors Practice which says Take it or Leave it we do not care. The NHS once they were aware fixed it in 2 days one day of which was to ensure there were no other problems and then the day of operation, I am fully satisfied with the NHS performance. But the practice should also be part of the NHS. they might then show the same care.

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