- About the British Social Attitudes survey
NatCen’s British Social Attitudes survey has been conducted almost every year since 1983. Overall, nearly 89,000 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.
Sample and approach
The 2013 survey consisted of 3,244 interviews with a representative sample of adults in England, Scotland and Wales. Addresses are selected at random and visited by one of NatCen Social Research’s interviewers. After selecting (again at random) one adult (aged 18 and over) at the address, 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 1,063 in 2013. 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 2013 for the health care questions was around +/-1 to 4 percentage points.
The 2013 survey was conducted between June and September.
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 led 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.
We would like to thank Jerome Finnegan, NatCen, for help in data extraction from BSA surveys.
Satisfaction with the NHS overall
Trends in satisfaction with the NHS overall
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 46 per cent up to 2004. Between 1997 and 1999, satisfaction rose from 34 to 46 per cent then fell back to 38 per cent in 2001 (an indication that the possible ‘honeymoon’ period for the then Labour government had ended). But from then onwards, 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. More recent data shows this drop to have been a step change, rather than the start of a continued decline. For the past three years, satisfaction has remained unchanged statistically, sitting at 60 per cent in both 2012 and 2013. While satisfaction levels have not recovered to the high of 70 per cent recorded in 2010, they remain high by historical standards. In only two of the past 30 years (2009 and 2010) have satisfaction levels been greater than those recorded in 2012 and 2013.
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 2013 remains the third highest since 1983 at 38 per cent (Figure 2).
Satisfaction with NHS and social care 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. Satisfaction declined to 73 per cent in 2011, and has remained at around that level since (74 per cent in both 2012 and 2013). Satisfaction with GP services remains fairly consistently high, showing less variation year on year than satisfaction with other services and the NHS overall.
By contrast, and apart from one year (2000), satisfaction with dentistry had been in long-term decline since the British Social Attitudes survey began. From a high of 74 per cent in 1986, it fell to just 42 per cent in 2006 and remained at that level through to 2008. Rates then began to climb, up to 56 per cent in 2011 and 2012. In 2013 the satisfaction rate of 57 per cent was statistically unchanged from the previous two years, but, with the exception of the year 2000, represents the highest level of satisfaction with NHS dentists since 1994.
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 declined, and, alone among the other NHS services, it fell again in 2012 to 52 per cent. In 2013 however, satisfaction increased by 6 percentage points to 58 per cent, almost back to its 20-year high reported in 2010, 2009, and 2000.
Satisfaction with NHS outpatient services was at its lowest recorded rate in 2001 (50 per cent). From then it climbed steadily (apart from a fluctuation in 2006) until 2009 and 2010 when it stabilised at 67 per cent. Satisfaction then dropped to 61 per cent in 2011, but has climbed in the two years since, and is now back to its highest recorded level of 67 per cent.
Satisfaction with social care in 2013 compared to satisfaction with NHS services
In 2013, public satisfaction with A&E services was lower than satisfaction with any other NHS service. After reaching their highest rate in 2010 (61 per cent) rates have fluctuated, declining to 54 per cent in 2011, jumping back up to 59 per cent in 2012, then dropping again in 2013 to 53 per cent. This fall in satisfaction will probably reflect in part well-publicised problems with breaches of the four-hour A&E minimum waiting time target in March and April last year.
Figure 5 brings together the 2013 results for satisfaction (and dissatisfaction) with the NHS overall and with its separate services. It also shows the results for satisfaction with social care. As in previous years, the public say they are most satisfied with GP services. Accident and emergency services received the lowest satisfaction ratings among NHS services, a change from 2012 when both inpatient and dentistry services had lower satisfaction ratings than A&E.
Satisfaction with social care services is considerably lower; just 29 per cent of respondents were very or quite satisfied with social care and 29 per cent were very or quite dissatisfied. Although an almost equal proportion (31 per cent) were neutral, and 12 per cent did not know, this represents quite a high level of dissatisfaction with social care. A similar question on social care satisfaction was also asked in 2012, with slightly different wording, but with similar results.
Who is satisfied with the NHS?
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 2013 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.
Because the British Social Attitudes survey also collects information on the particular characteristics of survey respondents – their party political identification, where they live and so on – we can explore the satisfaction data in more depth.
Recent contact with the NHS
As Figures 6 and 7 show, for example, there is a gap between the satisfaction levels reported by respondents who had recent experience of inpatient or outpatient services (defined as personal contact in the last 12 months) and those who did not. For many years since 1998 there has been a gap in satisfaction between these two groups; people with recent contact with either inpatient or outpatient services tend to report slightly higher levels of satisfaction than those with no recent contact.
This difference has varied over time. For example, for inpatients it has been as large as 18 percentage points (in 2001) in favour of those with recent contact. In 2010 and 2011 this gap disappeared, but in 2012 it opened up again and the latest results show it widening to +10 percentage points in favour of those with recent contact. For those with recent contact with outpatient services there is a similar pattern although the 2013 results show the largest gap (+13 percentage points) in the past 15 years.
In general the differences in satisfaction between those with recent experience and those without are likely in part to reflect negative media reporting about the NHS (influencing the views of those with no recent contact with the NHS) but also perhaps elements of gratitude and appreciation for care received which colour views on satisfaction for those with recent contact.
Party political identity
Another factor affecting satisfaction levels may be that views about the NHS expressed by 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). Following a year in which satisfaction with the NHS among supporters of the three main political parties converged, 2013 saw views diverge once again. Between 2012 and 2013, satisfaction increased slightly among Conservative supporters (up 3 percentage points), remained the same for Liberal Democrats, and dropped slightly among supporters of the Labour party (down 4 percentage points). To an extent the opposing changes in the satisfaction levels of Conservative and Labour supporters will have cancelled each other out, helping to maintain the steady trend overall.
Country of residence
Given changes in the governance of the NHS across Britain since devolution in Scotland and Wales and the apparent divergence in policy paths across these countries over the past decade or so, it is interesting to see whether such differences are reflected in satisfaction rates. Because of relatively small sample sizes for Wales and Scotland since 2011, the differences between countries each year since then are not statistically significant.
However, we can combine Scottish and Welsh responses. In general, there has been no significant difference in satisfaction rates between countries since the turn of the century – apart from 2011, when satisfaction in England was 58 per cent and in Scotland and Wales combined, 52 per cent. On this basis it would seem that the public appear unmoved in their attitudes towards the NHS regardless of any policy differences there have been and that remain between England and the rest of Britain, or differences in other factors likely to influence satisfaction (such as performance on waiting times).
As the results for 2013 show, while satisfaction with the NHS overall remains relatively high by historical standards, rates remain essentially unchanged compared to 2012, with little improvement since the sharp drop seen in 2011.
In 2011, 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 the public perception that the NHS was being run well.
While public concern about the NHS may well have persisted into 2013, there is little to suggest any increase in concern – which may prompt a deterioration in satisafaction. The fact that satisfaction remains at the levels reported in 2012 could be seen as a measure of success for the NHS in terms of broadly maintaining performance in areas that matter most to the public (such as waiting times), despite the continued financial pressure on the NHS across Britain. However, where performance does dip – for example, problems with waiting times in A&E in late winter and early spring last year – this is reflected in concomitant falls in satisfaction (in this case, with A&E services).