Reasons for being (dis)satisfied with the NHS

The data we get from the British Social Attitudes survey (conducted virtually every year since 1983 by NatCen Social Research) is invariably fascinating. It provides an insight into the views and feelings of the public across a wide range of issues – including health and social care – but interpreting this data can be difficult.

For example, one key question that The King’s Fund has sponsored for the past five years is:

The results for this question show a 5 percentage point fall in satisfaction in 2015 compared to a year earlier. This is a statistically significant drop, although at 60 per cent satisfaction is still relatively high in historical terms. The survey also shows dissatisfaction rising by 8 points to 23 per cent (see figure 1).

While the year-on-year results are interesting (as are the trends over time which suggest two distinct periods - before the turn of the century (when levels fluctuated) and after (when we see a more steady rise in satisfaction and fall in dissatisfaction levels), explaining the public’s responses has never been straightforward.

Think about how you would answer the question; it is clear that there are many factors that could influence your answer. Your recent personal experience of the NHS or your feelings about the NHS as an institution. You may have formed a general impression of the NHS from what you’ve read, seen or heard from the media. Maybe there was a high-profile event (a hospital scandal or a major policy change for the NHS) that occurred at the time of the survey and stuck in your mind.

Previous analyses of the satisfaction results have suggested that these are all possible factors in people’s responses.

There is also possible that satisfaction rises (or falls) simply because people really are more (or less) satisfied ‘…with the way in which the National Health Service runs nowadays’. However, when we look more closely at the data that interpretation seems unlikely. When we looked at the 2014 survey results we saw that overall satisfaction had risen, mainly driven by an increase in satisfaction among people identifying with the Labour party. It felt less plausible to interpret the overall change as a straightforward increase in satisfaction and more likely that the increase in satisfaction among Labour party supporters was influenced by something else – a desire to express support for the NHS perhaps?

To explore some of the underlying drivers of opinion we added additional questions to the 2015 survey asking respondents why they had expressed either satisfaction or dissatisfaction. The options for the final survey were derived from a pilot and were designed to capture the majority of reasons that people gave.

Figure 7 from the report shows the reasons the public gave for being very or quite satisfied with the NHS. The results suggest four or five key reasons for being satisfied with the NHS. Three relate broadly to the performance of the NHS: quality of care; attitudes and behaviour of staff; and acceptable waiting times. Two concern the nature and founding principles of the NHS itself: that it is free at the point of use and that it provides a wide range of services.

Those who said they were very or quite dissatisfied gave their top reasons as: long waiting times; staff shortages; underfunding; financial inefficiency; and quality of care.

There is more to explore within these results. For example, are there differences between age groups or political affiliation in the reasons cited for satisfaction and dissatisfaction? We will analyse this in more detail in the final report of the BSA survey results, which will be published later this year by NatCen.

• Read our report, Public satisfaction with the NHS in 2015