- Sample and approach
NatCen's British Social Attitudes survey has been conducted almost every year since 1983. Overall, nearly 85,000 people have taken part. A selection of health care-related questions – including those on satisfaction reported here – has been funded by The King's Fund since 2011. Other funders sponsor other questions on a variety of topics.
The 2012 survey consisted of 3,248 interviews with a representative sample of adults in Britain. Addresses are selected at random and visited by one of NatCen Social Research's interviewers. After selecting one adult (aged 18 and over) at the address (again at random), the interviewer carries out an hour-long interview. Most questions are answered by the participant selecting an answer from a set of cards.
The sample size for the health care questions reported here was 1,103. The data is weighted to correct for the unequal probabilities of selection, and for biases caused by differential non-response. The weighted sample is calibrated to match the population in terms of age, sex and region. The margin of error in 2012 for the health care questions was around +/-2 to 6 percentage points.
The 2012 survey was conducted between July and September, with a small number of interviews taking place in October and November.
- Topics and funding
The topics covered by the survey change from year to year, depending on the identities and interests of its funders. Some questions are asked every year, some every couple of years, and some less frequently.
The survey is funded by a range of charitable and government sources, which change from year to year. The survey is directed by NatCen Social Research. NatCen carries out research in the fields of social and public policy, uncovering the truth about people’s lives and what they think about the issues that affect them. As an independent, not-for-profit organisation, NatCen focuses its time and energy on meeting clients' needs and delivering social research that works for society.
Satisfaction with the NHS overall
The British Social Attitudes survey asks people how satisfied or dissatisfied they are with the way in which the NHS runs.
Trends in satisfaction with the NHS since 1983
Figure 1 shows trends in overall satisfaction with the NHS since 1983. Apart from two of the earliest years (1983 and 1984), satisfaction (ie, those who say they are either quite satisfied or very satisfied with the NHS) fluctuated between 34 per cent and 44 per cent up to 2004.
Between 1997 (the year the new Labour government took office) and 1999, satisfaction rose from 34 to 46 per cent then fell back to 39 per cent in 2001 (an indication that the possible 'honeymoon' period for the Labour government had ended). But from then, overall satisfaction with the NHS rose steadily to an all-time high of 70 per cent in 2010 – mainly reflecting rising levels of NHS funding and improvements in the things patients and the public cared about (such as shorter waiting times. This increase in satisfaction was generally mirrored by a decline in dissatisfaction.
However, 2011 saw the largest drop in satisfaction ever recorded by the British Social Attitudes survey, down to 58 per cent. The latest results for 2012 show an increase of 3 percentage points to 61 per cent, a change that is not statistically significant. While satisfaction levels have not recovered to the high of 70 per cent recorded in 2010, they remain high by historical standards.
Figure 1: Trends in satisfaction with the NHS since 1983*
Net satisfaction with the NHS overall
The proportion of people who are dissatisfied with the NHS overall is also low by historical standards. When we look at net satisfaction levels – that is, the number of people who are satisfied minus the number who are dissatisfied – the net difference between satisfaction and dissatisfaction in 2012 remains the third highest since 1983 at 38 per cent (Figure 2).
Figure 2: Net satisfaction* with the NHS overall**
Satisfaction with NHS and social care services
British Social Attitudes also asks people how satisfied or dissatisfied they are with some specific services.
Trends in satisfaction with GP and NHS dentistry services
Figure 3 shows trends for satisfaction with GP and NHS dentistry services. Satisfaction with GP services has traditionally been high – ranging from a low of 71 per cent in 2001 to 80 per cent in 2009. In recent years satisfaction has declined slightly, to 74 per cent in 2012.
By contrast, and apart from one year (2000), satisfaction with dentistry had been in long-term decline until 2009, when satisfaction increased from 42 per cent (in 2008) to 48 per cent, increasing to 56 per cent in 2011. This recovery has not continued into 2012, when satisfaction remained flat at 56 per cent.
Figure 3: Trends in satisfaction with GP and NHS dentistry services*
Trends in satisfaction with inpatient, outpatient, and accident and emergency services
Figure 4 shows trends in satisfaction for three hospital-based services: inpatients, outpatients, and accident and emergency (A&E). As with NHS dentistry, satisfaction with inpatients declined steadily from 1983 through to 2006 and then increased steadily to nearly 60 per cent in 2010. In 2011, however, satisfaction with inpatients declined, and, alone among the other NHS services, it fell again in 2012 to 52 per cent.
On the other hand, satisfaction with both outpatient and accident and emergency services rose in 2012. Satisfaction with A&E rose to 59 per cent, one of the highest levels recorded by the British Social Attitudes survey and a statistically significant increase from 2011. Moreover, for the first time, satisfaction with A&E is significantly higher than satisfaction with inpatient services. Satisfaction with outpatients now stands at 64 per cent – its third highest level since 1983 – a small and statistically insignificant increase since 2011 (61 per cent).
Figure 4: Trends in satisfaction with inpatient, outpatient and accident and emergency services**
Satisfaction with social care in 2012 compared to satisfaction with NHS services
Figure 5 brings together the 2012 results for satisfaction (and dissatisfaction) with the NHS overall and with its separate services. It also shows the results for satisfaction with social care. Similar questions about satisfaction with social care have been asked in some previous surveys, but, as there have been changes in wording, comparisons are not made here.
Just 30 per cent of respondents were very or quite satisfied with social care and 31 per cent were very or quite dissatisfied. However, an almost equal proportion (28 per cent) were neutral, and 11 per cent did not know; both these responses were significantly higher than for NHS services and might indicate a relative lack of knowledge about social care services rather than a low satisfaction.
Figure 5: Satisfaction with social care in 2012 compared to NHS services*
Explaining the results
Apart from the increase in satisfaction with A&E services between 2011 and 2012, there has been little change in levels of satisfaction with NHS services. Why is this?
Trends in satisfaction with the NHS by recent contact with inpatients and outpatients
Explaining changes in satisfaction with the NHS and its services from year to year can be difficult; rarely is there a single factor at play. In general, there are a number of potential reasons for change, or, in the case of the 2012 result for satisfaction with the NHS overall, effectively no change. For example, satisfaction with the NHS will be partly dependent on the public’s expectations of the NHS, actual or perceived changes in the quality of NHS care and so on. In addition, people’s attitudes towards the NHS are likely to be influenced by their view about other things, in particular about the government and its policies concerning the NHS.
Why has satisfaction with the NHS and most of its services remained essentially unchanged from 2011?
The key result from the 2012 survey is that satisfaction with the NHS and most of its services remain essentially unchanged following the big fall in 2011. As we note, part of the explanation for this could be that the actual or perceived quality of NHS care has remained unchanged. Indeed, key measures of performance likely to have been noticed by the public – for example, waiting times either in A&E departments or for outpatients and inpatients, and for health care-acquired infections – have not significantly changed from 2011 to 2012 (as seen in our September 2012 quarterly monitoring report); furthermore, there is no significant change in satisfaction for respondents who have had recent contact with the NHS.
As Figures 6 and 7 show, there is essentially no difference in satisfaction with the NHS overall between respondents who had recent experience of inpatient or outpatient services (defined as personal contact in the last 12 months, or contact via a close family member/friend, or both personal contact and via close family member/friend) and those who did not, and effectively no difference between 2011 and 2012 levels of satisfaction for both groups.
Figure 6: Trends in satisfaction* with the NHS by recent contact** with inpatients
Figure 7: Trends in satisfaction* with the NHS by recent contact** with outpatients
Trends in satisfaction with the NHS by party identification
Another reason for satisfaction remaining broadly unchanged may be that views about the NHS expressed by some or all respondents are based on their views about something else – in particular about the government and/or its policies concerning the NHS. Previous analyses of British Social Attitudes survey satisfaction results have noted a tendency for levels of satisfaction with the NHS overall to correlate with the party in government, with those identifying themselves as supporters of the party in power expressing greater satisfaction than non-supporters (see Figure 8).
What does satisfaction by party identification look like in 2012?
But as Figure 8 shows, while this association appears broadly true over time, it is less true of the results for 2012. In 2012 there is little difference in levels of satisfaction by party identification: 64 per cent of both Conservative and Labour supporters are satisfied with the NHS overall, as are 63 per cent of Liberal Democrat supporters. For Liberal Democrats, this continues a decline from a high of 74 per cent satisfied in 2010. For Labour supporters, on the other hand, satisfaction has risen since 2011 by 7 percentage points – a statistically significant increase following the large fall between 2010 and 2011 of more than 17 percentage points. For Conservative supporters, satisfaction in effect remains flat at 64 per cent (lower than a high of 70 per cent in 2010).
These changes would suggest that the general association between respondents’ party identification, the party in power and satisfaction with the NHS does not, for now, hold true. Equally, however, the fact that Liberal Democrat and Conservative party supporters’ satisfaction has at best remained flat (and down on their 2010 views) may reflect some ambivalence about the coalition government’s performance and policies among its supporters.
The (statistically significant) increase in satisfaction among Labour supporters is also difficult to explain on the basis of the historic association between the party in power and the attitudes expressed by respondents according to party identification. In part, it may simply reflect an inevitable recovery following a very large fall. In part, too, there may be some reaction to what Labour supporters may have perceived as general ‘negativity’ towards the NHS. In other words, their attitudes may reflect a general vote of support for the NHS at a time when they may have thought it was under attack, rather than specific satisfaction with the NHS.
Figure 8: Trends in satisfaction with the NHS by party identification
As these new results show, while satisfaction with the NHS overall remains high by historical standards, there has been little improvement since the sharp decline seen in 2011. In effect, there has been little or no recovery from the big fall in satisfaction recorded in 2011.
In the 2011 British Social Attitudes survey report, we suggested that the 12 percentage point drop in satisfaction reflected a combination of response to ministerial rhetoric to justify the government’s reforms of the NHS (poor performance and hence a need for change), concern about the reforms themselves, and reaction to the funding squeeze. These created generalised worries about the NHS and dented public perception that the NHS was being run well. While public concern about the NHS may well have persisted into 2012, there is little to suggest any increase in concern – and hence a deterioration in satisfaction.
This survey, though carried out over a number of months, can only ever be a snapshot of opinion at a given point in time and can be influenced by a number of things that do not relate directly to people’s experience of the NHS. It will be fascinating to see how the next survey, to be conducted over the summer of this year, will reflect the public’s attitudes towards the NHS as it enters its first year of the implementation of the government's reforms of the NHS, its fourth year of near-zero increase in real funding and in the wake of the Francis report on Mid Staffordshire NHS Foundation Trust.