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


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.

Figure 1: Public satisfaction with the NHS, 1983 to 2016

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.