British Social Attitudes: Satisfaction with the NHS falls to the lowest level ever recorded

Public satisfaction with the NHS has slumped to its lowest level ever recorded by the British Social Attitudes Survey (BSA), with A&E services seeing the biggest year to year increase in dissatisfaction, according to analysis published today by the Nuffield Trust and The King’s Fund.

The 40th BSA survey was conducted by the National Centre for Social Research (NatCen) in September and October 2022 and is seen as a gold standard measure of public attitudes. Overall satisfaction with the NHS now stands at 29 per cent - a fall of 7 percentage points from the previous year (2021) and the fourth largest year-on-year drop recorded. The British public now has the lowest level of satisfaction with the NHS since the BSA survey began in 1983. Dissatisfaction is also at an all-time high, with more than half (51 per cent) of respondents saying they were dissatisfied with the NHS.

More than two-thirds of respondents (69 per cent) chose long waiting times for GP and hospital appointments as one of the top reasons for dissatisfaction.

Accident and emergency services have seen a sharp increase in the percentage of dissatisfied respondents. A record 40 per cent of respondents said they were dissatisfied with A&E services, an increase of 11 percentage points from the previous year and the largest increase in a single year since the question on A&E services was introduced in 1999. Only 30 per cent of people said they were satisfied with A&E services.

There were also falls in public satisfaction across all other individual NHS services, including general practice, dentistry, and in-patient hospital services, with all services now reaching record levels of low satisfaction.

Despite this, and consistent with last year’s survey, the public continues to show very strong support for the principles underpinning the NHS. The overwhelming majority of respondents agreed that the founding principles of the NHS should ‘definitely’ or ‘probably’ apply, with 9 in 10 respondents backing the principle that the NHS should be free of charge when you need it and more than 8 in 10 respondents supporting the principles that the NHS should be available to everyone and primarily be funded through taxes. 

The report, Public satisfaction with the NHS and social care in 2022 also highlights the following. 

• The fall in overall satisfaction with the NHS was seen across all ages, income groups, sexes and supporters of different political parties
• The main reasons people gave for being dissatisfied with the NHS were waiting times for hospital and GP appointments (69 per cent), staff shortages (55 per cent) and a view that the government does not spend enough money on the NHS (50 per cent). 
• Of those who were satisfied with the NHS, the top reason was that NHS care is free at the point of use (74 per cent), followed by the quality of care (55 per cent) and the range of services and treatments available (49 per cent). 
• There was a jump in the proportion of people who chose improving A&E waiting times as a priority for the NHS, from 38 per cent in 2021 to 47 per cent in 2022, taking improving A&E waits into the top three highest priorities.
• Satisfaction with GP services fell to 35 per cent in 2022, down from 38 per cent in 2021. This is the lowest level of satisfaction recorded since the survey began. The fall was much less sharp than between 2019 and 2021 when satisfaction fell by 30 percentage points. 
• Satisfaction with NHS dentistry fell to a record low of 27 per cent and dissatisfaction increased to a record high of 42 per cent. 24 per cent of respondents said they were ‘very dissatisfied’ with NHS dentistry – a higher proportion than for other health and care services asked about in the survey.
• Just 14 per cent of respondents said they were satisfied with social care, with only 2 per cent indicating they were very satisfied.
• There was a sharp increase in dissatisfaction with social care, with 57 per cent of people saying they were dissatisfied (up from 50 per cent in 2021).
• Dissatisfaction with social care is higher than dissatisfaction with the NHS overall or any of the individual NHS services asked about – general practice, dentistry, inpatient, outpatient, and A&E services. 

Jessica Morris, report author and Fellow at the Nuffield Trust, said: 

‘Behind the political upheaval and turmoil playing out at the time of this survey, the British public was sending a message about the worsening situation for the NHS. The fact we have now recorded the lowest level of satisfaction with the NHS in the 40-year history of this gold standard survey is a warning siren. The rate of decline has slowed from the previous year, but that is barely a silver lining given the challenges and impact of the pandemic.

‘This 2022 British Social Attitudes survey points to a sustained and worsening concern about every part of the health service. What’s more, for some key services waiting times are now worse than when the survey was conducted.

‘The Prime Minister has made recovering the NHS one of his central promises going into the next general election. But these results show what an enormous task this will be. It is clear that the level of unhappiness among the British public over the way the NHS is running is going to take many years to recover.’ 

Dan Wellings, report author and Senior Fellow at The King’s Fund, said: 

‘It is easy to become desensitised to the relentless flow of bad news about struggling health services, but we cannot underestimate the significance of today’s unprecedented results. These stark findings should act as a wake-up call to those in power. 

‘In 2010, satisfaction with the NHS stood at a record high of 70 per cent. Yet, satisfaction has now plummeted to its lowest ever level, at just 29 per cent. The public can see for themselves the results of more than a decade of underfunding and a lack of workforce planning. People are struggling to get the care they need, particularly in an emergency, which is born out in the extraordinary spike in dissatisfaction with A&E services. The high-profile pressures in emergency departments are symptomatic of challenges right across the board, with every service covered by the survey seeing record low levels of satisfaction. 

‘Even with satisfaction dropping to its lowest ever level, support for the founding principles of the NHS remains strong. The public do not want a different model of health care, they just want the current model to work.’