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Public perceptions of the NHS in 2020

The British Social Attitudes survey has provided years of insight into public perceptions of the NHS. In 2020, in the midst of the Covid-19 pandemic, the survey asked only one question about health and care issues. Here, Dan Wellings and John Appleby share the data collected.

Since 1983, the National Centre for Social Research’s (NatCen) British Social Attitudes (BSA) survey has asked members of the public – rather than only patients – in England, Scotland and Wales about their views on the NHS and health and care issues generally. Due to the Covid-19 pandemic, the usual methodology of the BSA was adapted and the survey was conducted online rather than face to face. Only one question was asked about overall satisfaction with the NHS. Changes in the survey method mean that comparisons over time need to be considered with caution (see box below for more details).

During October and November 2020 NatCen asked 1,275 members of the public about their satisfaction with the NHS overall.

Overall satisfaction with the NHS in 2020

Bearing in mind the health warning about comparing the 2020 survey with previous years, when asked, ‘All in all, how satisfied or dissatisfied would you say you are with the way in which the National Health Service runs nowadays?’, 53 per cent of respondents said they were very or quite satisfied, a drop of 7 percentage points between 2019 and 2020 (a statistically significant change).

Within this, the biggest fall was those people saying they were very satisfied (a drop from 17 per cent to 12 per cent). The percentage saying they were very or quite dissatisfied remained more or less unchanged, and those saying they were neither satisfied nor dissatisfied rose by 7 percentage points.

A line graph showing Public satisfaction with the NHS, 1983 to 2020

The survey data also allows us to look at the differences in satisfaction according to political affiliation. Satisfaction among Conservative supporters remained higher than among Labour supporters though overall satisfaction with the NHS fell for both groups – from 59 per cent satisfied in 2019 to 53 per cent in 2020 for Labour supporters (though this is not statistically significantly different) and from 68 per cent in 2019 to 57 per cent in 2020, for Conservative supporters (which is statistically significant).

A line graph showing  Public satisfaction with the NHS by party political affiliation, 1983 to 2020

As we have noted in previous BSA survey analyses, pinpointing exactly why satisfaction changes from year to year is difficult. Given the changes in methodology this year and the pace with which public opinion has been changing over the course of the pandemic, we will not be providing commentary or analysis on the 2020 results.

The health and care system faces a hugely difficult time as it tackles a third wave of Covid-19, delivers the largest-ever vaccination programme in its history and addresses an acceleration in the backlog of people waiting for care – starkly reflected in some of the longest waiting lists and times in many years.

The public reaction to how well the NHS (and government) manage these pressures will be revealed as the full set of health and care questions is asked in the 2021 BSA survey. The King’s Fund and the Nuffield Trust will sponsor these questions, and results will be published, with commentary, in 2022.

How the 2020 survey was carried out

Public health measures introduced as a result of Covid-19 meant that the 2020 BSA survey could not be run in its usual way. Interviewing the public face to face was not possible and instead, the survey was conducted online. The Nuffield Trust and The King’s Fund – joint sponsors of a set of health and care questions for many years – decided not to go ahead with the usual question set.

However, NatCen ran one question: All in all, how satisfied or dissatisfied would you say you are with the way in which the National Health Service runs nowadays? – a question that has been asked every year since 1983.


BSA 2020 was a push-to-web survey of adults (aged 18+) living in private residential households in Britain. It was designed to encourage respondents to complete the survey online but offered the option of completing the survey by telephone if requested.

An unclustered random probability sample of addresses was selected from all addresses in England, Scotland and Wales (excluding addresses located North of the Caledonian Canal and on the Isles of Scilly, for consistency with previous years of BSA). The Postcode Address File (PAF) was used as the sampling frame.

Selected addresses were sent up to three mailings – an invitation and two reminders – and up to two adults from each household were invited to take part. Data was collected between 23 October and 30 November 2020.

In total 1,275 people responded to the NHS satisfaction question in the survey (compared to around 3,000 in previous years’ surveys for the NHS satisfaction question)

Comparability with previous BSA surveys

The change from interviewer-administered face-to-face surveys to online self-completion by respondents brings a risk of measurement effects; that is, differences observed between the face-to-face and self-completion surveys may be caused by the mode of the survey rather than genuine changes in attitudes. An effort has been made to reduce measurement effects as much as possible, through careful questionnaire design, and indicative comparisons where possible.

However, measurement effects can’t be eliminated entirely and, as such, comparisons over time should be considered with caution.