Public satisfaction with NHS plummets in 2011

The British public's satisfaction with the way the NHS runs took a nose dive in 2011 – falling from 70 per cent (its highest ever level) to 58 per cent. This was the largest fall in any year since the British Social Attitudes survey began in 1983. If that wasn't enough, what makes this drop even more notable is that it comes after almost continuous annual improvements in satisfaction since 2001 (2004 was the one exception).

These results are mirrored in satisfaction with different NHS services too. Satisfaction with inpatient, outpatient and accident and emergency services all fell in 2011 – by between 5 and 7 percentage points. Even satisfaction with GPs, traditionally very high, fell in 2011 following a fall in 2010 too.

The one service to buck the trend was dentistry with a 5 percentage point rise in 2011, continuing increases in 2009 and 2010.

But despite the good news for dentistry – probably a reflection of increasingly better access to dentists carrying out NHS work – and while one data point doesn’t make a trend, the overall picture is disappointing.

Interpreting satisfaction polls can be difficult. Should we, for instance, take the drop in satisfaction as an indication of a drop in the performance of the NHS? Probably not. Waiting times and rates of health care acquired infections – two key performance measures for the public – remained broadly unchanged or, in the case of MRSA and C. difficile, continued to fall over the time the survey fieldwork was carried out (June to November 2011). Despite some well-publicised failures, there is no evidence of deterioration in the quality of care according to patient experience surveys.

However there are other factors which could provide an explanation. For example, we know from analysis of past surveys that there is a link between expressions of satisfaction with the NHS, the political party people identify with, and the party in government. The year 2010 saw a change of government and although satisfaction rose overall, a breakdown of the figures shows this was driven entirely by Conservative and Liberal Democrat supporters' attitudes; satisfaction among Labour supporters was virtually unchanged compared to 2009. However, in 2011, not only did Labour supporters’ satisfaction fall dramatically – so too did satisfaction among Conservative and Liberal democrat supporters. This seems to suggest some other factors influencing attitudes towards the NHS, as well as an element of political partisanship.

Newspapers, television and other media are key sources of information for many about the NHS. So what was trending last summer? In England at least, headline news was a very polarised and heated debate about the government’s proposed reforms of the health service. Reports of opposition to the reforms were high profile and, regardless of the merits of arguments on both sides, will have no doubt contributed, at a minimum, to a climate of uncertainty in the public’s minds about the NHS and its future. Government rhetoric about the relatively poor performance of the NHS compared to other countries and the need to cut bureaucracy (used to support their case for reform) will have also contributed to this.

Apart from media headlines and unease about the possible impact of the government’s reforms to one of Britain’s best loved institutions, the other notable policy factor that is likely to have filtered through to the public’s consciousness is the virtual, real-terms freeze in NHS funding and the associated programme to improve productivity. However, the language associated with this is unlikely to have been reassuring to many: If the NHS says it is making savings, many may well hear the word 'cuts', for example.

Put all these factors together and we start to see a picture emerging: public discontent and worry – not necessarily with the way the NHS is performing now, but with its future – which sees its expression in lower levels of satisfaction.

As for the future, the 2012 British Social Attitudes survey will be in the field this summer with headline satisfaction results available early next year.

Given the controversy about the health reforms will still be fresh in people’s minds, as will the industrial action being taken later this month by doctors over pensions, the worry – both for the government and the BMA – must be whether this year’s dip in satisfaction with the NHS and GP services is a one-off or a sign of things to come.