Public satisfaction with the NHS in 2014

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Part of Public satisfaction with the NHS

Since 1983, the National Centre for Social Research’s British Social Attitudes survey has asked the public – rather than simply patients – about their views on and feelings towards the NHS and health care issues generally. This is page 2 of 8 of our full report. The latest survey was carried out between August and September 2014. It presents a picture of the public’s satisfaction with the way the NHS runs, with important services, such as GPs, inpatients and outpatients, and with social care provided by local authorities.

Here we present the top-line results and trends from the survey. A further paper, co-authored by NatCen and The King’s Fund covering these and the results from a number of other health and health care questions, will be published as part of NatCen’s annual British Social Attitudes report in spring 2015.

The following gives an overview of changes in satisfaction levels over time together with analyses of satisfaction by sub-groups of the population, such as respondents’ recent contact with the NHS or not, or party political affiliation.

Key points

  • Overall public satisfaction with the NHS increased to 65 per cent in 2014 – the second highest level since the British Social Attitudes survey began in 1983. Dissatisfaction with the service fell to an all-time low of 15 per cent.
  • GP services remain the most popular NHS service in terms of satisfaction, with 71 per cent satisfied in 2014.
  • Dentistry continued to have lower satisfaction ratings than other NHS services: in 2014 just over half of respondents were satisfied with the service.
  • Outpatient services experienced an all-time high in satisfaction levels of 69 per cent in 2014, almost rivalling general practice as the most popular NHS service.
  • Inpatient services showed little change with a satisfaction rating of 59 per cent.
  • For accident and emergency (A&E) services, satisfaction increased from 53 to 58 per cent between 2013 and 2014, after fluctuating in previous years.
  • Social care had far lower satisfaction levels than NHS services – just one-third of respondents reported being satisfied, less than half the level reported for the NHS overall.
  • Satisfaction among respondents with no recent contact with the NHS jumped 11 percentage points between 2013 and 2014, compared to a 4 percentage point increase among those with recent contact.
  • Labour supporters’ levels of satisfaction with the NHS also jumped 11 percentage points, those for Conservative supporters remained roughly the same and Liberal Democrat satisfaction levels increased by 5 percentage points.
  • The increase in satisfaction with the NHS during a year in which the service was under much publicised financial pressure and with notable difficulties with A&E waiting times may in part reflect an actual increase in satisfaction, but also a desire among the public to show support for the health service. Read our conclusion

Since 1983, the National Centre for Social Research’s British Social Attitudes survey has asked the public – rather than simply patients – about their views on and feelings towards the NHS and health care issues generally. The latest survey was carried out between August and September 2014. Here we present the top-line results and trends from the survey. This is page 7 of 8 of our full report.

NatCen’s British Social Attitudes survey has been conducted almost every year since 1983. Overall, more than 92,000 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 2014 survey consisted of 2,878 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. The participant answers most questions by selecting an answer from a set of cards.

The sample size for the overall NHS satisfaction question reported here was 1,937 in 2014; for questions about satisfaction with other NHS services the sample size was 971. 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 2014 for the health care questions was around +/- 1.8 to 3.8 percentage points.

The majority of field work for the 2014 survey was conducted between August and September, with a small number of interviews taking place in October and November.

Topics

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.

Funding

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.

References

Appleby J (2012). Public satisfaction with the NHS and its services: headline results from the British Social Attitudes survey. The King’s Fund website. Available at: www.kingsfund.org/projects-bsa-results-2011 (accessed on 24 April 2014).

Appleby J, Lee L (2012). ‘Does the NHS need to change and if so, how?’ in Park A, Clery E, Curtice J, Phillips M, Utting D (eds), British Social Attitudes: the 29th report. London: NatCen Social Research. Available at: www.bsa-29.natcen.ac.uk/read-the-report/health/satisfaction-with-the-nhs.aspx (accessed on 24 April 2014).

Appleby J, Robertson R (2010). ‘A healthy improvement? Satisfaction with the NHS under Labour’ in Park A, Curtice J, Clery E, Bryson C (eds), British Social Attitudes – the 27th report: exploring Labour’s legacy. London: Sage. Available at: www.uk.sagepub.com/books/Book235675 (accessed on 24 April 2014).

Ipsos MORI (2014) Economist/Ipsos MORI December 2014 Issues Index. Available at: www.ipsos-mori.com/researchpublications/researcharchive/3496/EconomistIpsos-MORI-December-2014-Issues-Index.aspx (accessed on 16 January 2015).

Acknowledgements

Many thanks to Ian Simpson and Eleanor Taylor from NatCen for their assistance with data analysis and to Anna Brown for editorial support. We would also like to thank our King’s Fund colleagues Chris Ham and Patrick South for providing helpful comments on the results. Most importantly we would like to thank the British public for the time they took to complete this survey and for providing us with this fascinating dataset.

Satisfaction with the NHS overall

Since 1983, the National Centre for Social Research’s British Social Attitudes survey has asked the public – rather than simply patients – about their views on and feelings towards the NHS and health care issues generally. The latest survey was carried out between August and September 2014. Here we present the top-line results and trends from the survey. This is page 3 of 8 of our full report.

Figure 1 shows trends in overall satisfaction with the NHS since 1983. Satisfaction rose steadily throughout the 2000s, from 38 per cent in 2001 to an all-time high of 70 per cent in 2010. This was likely to be a result of increased NHS funding during that period which led to improvements in things that patients and the public cared about, such as shorter waiting times (Appleby and Robertson 2010).

However, 2011 saw the largest drop in satisfaction ever recorded by the survey, down to 58 per cent (Appleby 2012). Following a few years in which satisfaction levels remained largely unchanged, the data for 2014 shows an increase to 65 per cent, the second highest level since 1983. At the same time, the proportion of people dissatisfied with the NHS reached an all-time low of 15 per cent.

These figures may reflect a straightforward increase in satisfaction with the health service in 2014. But they may also reflect other factors, such as the public’s response to media coverage of NHS financial pressures, explored in depth later in this report.

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 2014 is 50 per cent, larger than in any other year except 2010 (Figure 2).

Satisfaction with NHS and social care services

Since 1983, the National Centre for Social Research’s British Social Attitudes survey has asked the public – rather than simply patients – about their views on and feelings towards the NHS and health care issues generally. The latest survey was carried out between August and September 2014. Here we present the top-line results and trends from the survey. This is page 4 of 8 of our full report.

GP and NHS dentistry services

British Social Attitudes also asks people how satisfied or dissatisfied they are with specific NHS services. Figure 3 shows trends for satisfaction with GP and NHS dentistry services.

Satisfaction with GP services has traditionally been high, with less variation year on year than other services and the NHS overall. However, since 2009 satisfaction with GP services has generally shown a downward trend. In 2014 it reached 71 per cent, the lowest reported level since the survey began.

Public satisfaction with dentistry is consistently lower than with other NHS services. However, following nearly 20 years of decline, and a period of plateau, satisfaction has been improving in recent years. Between 2013 and 2014 reported satisfaction declined from 57 to 54 per cent, the first year-on-year decline in eight years, although the change was within the survey’s margin of error.

Inpatient, outpatient and A&E services

Figure 4 shows trends in satisfaction for three hospital-based services: inpatients, outpatients and A&E.

As with NHS dentistry, satisfaction with inpatients declined steadily from 1983 through to 2006 before increasing 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. For the past two years, levels of satisfaction have improved, reaching 59 per cent in 2014.

For the past decade, the public has viewed outpatient services more positively than inpatient care. Since 2010 satisfaction with outpatient services has been increasing, and it reached an all-time high in 2014 of 69 per cent.

Recent data on satisfaction with A&E services has fluctuated, with no clear pattern. After reaching its highest rate in 2010 (61 per cent), satisfaction dropped to 54 per cent in 2011, jumped back to 59 per cent in 2012, dropped to 53 per cent in 2013 and in 2014 was up once again to 58 per cent.

NHS and social care services

Figure 5 brings together the 2014 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 satisfaction with GPs has been declining over the past few years while satisfaction with outpatient services has improved, there is now little difference in levels of satisfaction with the two services. Dentistry received the lowest satisfaction ratings among NHS services, a change from 2013 when satisfaction with A&E services was lower.

Satisfaction with social care services is considerably lower than for NHS services; just 31 per cent of respondents were very or quite satisfied with social care provided by local authorities and 30 per cent were very or quite dissatisfied. An equal proportion (30 per cent) were neutral, and 8 per cent did not know, suggesting many respondents are less certain about their views on social care as opposed to health services. This may reflect a lack of familiarity with social care services combined with relatively less media attention on social care. The results are similar to 2013 when 29 per cent of respondents reported that they were satisfied and 29 per cent were dissatisfied with social care.

Who is satisfied with the NHS?

Since 1983, the National Centre for Social Research’s British Social Attitudes survey has asked the public – rather than simply patients – about their views on and feelings towards the NHS and health care issues generally. The latest survey was carried out between August and September 2014. Here we present the top-line results and trends from the survey. This is page 5 of 8 of our full report.

Explaining changes in satisfaction with the NHS and its services from year to year can be difficult. While these changes can in part be taken at face value – as actual shifts in satisfaction – in general, there are a number of potential reasons for change. For example, satisfaction with the NHS will be partly dependent on what the public expects from it, actual or perceived changes in the quality of NHS care and so on. People’s attitudes are also likely to be influenced by their views about the government and its policies on the NHS, by media reporting and by attitudes to the NHS as an institution.

Because the British Social Attitudes survey collects information on the particular characteristics of survey respondents – their party political identification, use of the health service and so on – we can explore the satisfaction data in more depth.

Recent contact with the NHS

As Figures 6 and 7 show, 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 by those who had not (defined as no contact personally or by friends or family members in the past 12 months).

For many years since 1998 there has been a gap in satisfaction between these two groups; people with recent contact 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. By 2011 this gap had disappeared, but in 2012 it opened up again and in 2013 the gap was 10 percentage points.

The latest year’s data shows the gap narrowing to just 3 percentage points. This was due to an 11 percentage point jump in satisfaction among those who had no recent contact with the health service. This overshadowed the 4 percentage point increase among those with recent personal contact.

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) but also perhaps elements of gratitude and appreciation for care received felt by those with recent contact.

During the period that the survey was in the field (August to September 2014), there were a number of high-profile negative media stories about the NHS – perhaps making the jump in satisfaction among those without recent contact surprising. Of course, the increase could reflect positive reports of NHS care from people they know, or reactions to some of the more positive media coverage of NHS services.

However, given the much publicised financial pressures and difficulties in meeting waiting times targets in 2014, an alternative interpretation would be that the positive views reflect a desire to stand up for the service or express solidarity for it during a difficult time.

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 those identifying themselves as supporters of the party in government to express greater levels of satisfaction with the NHS overall than non-supporters (see Figure 8). However, in 2014, satisfaction levels among supporters of the three main political parties converged; 67 per cent of Conservative supporters, 68 per cent of Liberal Democrats, and 69 per cent of Labour supporters reported being satisfied with the NHS.

This contrasts with a year earlier, when satisfaction levels among Labour supporters were 8 percentage points lower than among Conservatives. The gap was closed by an 11 percentage point increase in satisfaction levels among Labour supporters in 2014.

This increase in satisfaction among Labour supporters could be a straightforward reflection of an improvement in satisfaction. More likely – as with the explanation for the large increase in satisfaction among those with no recent contact with the NHS – this change could reflect more generalised support for the NHS as an institution at a time when some see it as under threat.

Satisfaction among supporters of the UK Independence Party – the third largest political group in the 2014 survey – was lower than the other main political parties at 57 per cent.

Country of residence

It is interesting to see how satisfaction rates vary across the different nations of Britain, particularly given changes in the governance of the NHS since devolution in Scotland and Wales and the degree of divergence in policy paths across these countries over the past decade or so. Another factor to consider is the political events, debates and media stories surrounding the Scottish independence referendum last year.

Bearing in mind the statistical caveat that the sub-sample for Scottish respondents has not been designed to be necessarily representative of the Scottish population as a whole, in 2014, satisfaction with the NHS in Scotland was 75 per cent, the highest ever recorded. This was significantly higher than satisfaction levels reported in England (65 per cent) and Wales (51 per cent). The gap in satisfaction between Scotland and the other two countries is now one of the largest since 1983.

The field work for this survey was conducted in the months running up to the referendum vote on Scottish independence in September 2014. The historically high levels of satisfaction reported in Scotland may in part reflect the sense of nationalism and pride evoked during the campaign.

On the other hand, in Wales, media reports of failures in the NHS and lengthening waiting times may explain the lower satisfaction levels.

Conclusion

Since 1983, the National Centre for Social Research’s British Social Attitudes survey has asked the public – rather than simply patients – about their views on and feelings towards the NHS and health care issues generally. The latest survey was carried out between August and September 2014. Here we present the top-line results and trends from the survey. This is page 6 of 8 of our full report.

The results of the 2014 British Social Attitudes survey show an increase in the public’s level of satisfaction with the NHS between 2013 and 2014. This may represent a genuine feeling among the public that the health service improved in 2014.

Official measures of performance tell a different story: NHS funding has been under increasing pressure since 2010 and there have been well-publicised performance problems with high-profile targets such as the 4-hour A&E waiting time standard and the 18-week maximum wait from referral to treatment. At the same time, the media has featured negative stories about the financial position of NHS hospitals and the need for additional investment in the service.

Growing public concern about the NHS can be seen in the results of a monthly survey conducted by Ipsos MORI. This shows that the public now considers the NHS as neck-and-neck with the economy as one of the top three issues facing Britain today (Figure 10).

Media coverage of the NHS: August and September 2014

Three main stories dominated media coverage about the NHS before and during the time the field work for the survey was conducted.

The first was deteriorating NHS finances and the growing number of NHS trusts that were running up deficits.

Second was the debate about funding and calls for more investment in the NHS, which culminated in pledges to increase funding from all the main parties at their party conferences.

Third were pressures on services and the impact of this on waiting times – in particular, waiting times for cancer treatment which were widely reported as having been missed while the field work was being conducted.

But the biggest story during this period centred on the Scottish referendum. For a short time in the run-up to the referendum, the NHS dominated the headlines as the two campaigns traded blows about the implications of independence for the NHS in Scotland.

This context suggests a possible alternative explanation for the increase in satisfaction in 2014. We know that what drives changes in satisfaction is not straightforward – and almost certainly is never simply satisfaction with the NHS per se, for all respondents to the survey. Political beliefs, attitudes towards the government of the day, media stories and expectations of the NHS will shape people’s satisfaction.

One interpretation of the increase in overall satisfaction for the NHS is that it is likely to reflect a vote of support for the NHS as an institution in difficult times. A lack of objective improvement in NHS services and the fact that improvements in satisfaction appear to have been driven by an 11 percentage point increase in satisfaction among Labour supporters and those without recent contact with the service, may lend weight to this analysis. This may especially be the case given that some see the NHS as currently under threat, for example from privatisation, and some feel ministers and others have been too critical of the NHS and its staff.

In the run-up to the 2015 general election, indicators like the British Social Attitudes survey will be increasingly drawn on to help the media and the public judge the government’s performance in running the NHS. However, the results of the latest survey should be interpreted carefully. As our analysis shows, public satisfaction reflects a multitude of factors other than actual satisfaction with the NHS.

So, while satisfaction improved in 2014, this is not necessarily synonymous with an improvement in the actual performance of the NHS, nor does it simply reflect an actual improvement in satisfaction. Nevertheless, it is clear that public satisfaction with the NHS and support for it as an institution remains high.

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