Public satisfaction with the NHS in 2016

• Public satisfaction with the NHS overall was 63 per cent in 2016. The change in satisfaction since 2015 was not statistically significant.
• Satisfaction with GP services was 72 per cent and, as in previous years, was higher than satisfaction with any other NHS service. Again, the change in satisfaction since 2015 was not statistically significant.
• Satisfaction with NHS dentistry services was 61 per cent in 2016, up by 7 percentage points from 2015. This is one of the highest levels of public satisfaction with these services since the early 1990s.
• Satisfaction with social care services was 26 per cent, unchanged since 2015 and far lower than satisfaction with NHS services. Social care is the only service to have a negative net satisfaction score.
• Satisfaction with outpatient services was 68 per cent in 2016. The change in satisfaction from 2015 was not statistically significant.
• Satisfaction with inpatient services was 60 per cent in 2016. The change in satisfaction since 2015 was not statistically significant.
• Satisfaction with accident and emergency (A&E) services was 54 per cent in 2016. Again, the change in satisfaction from 2015 was not statistically significant.
• Overall satisfaction with the NHS was higher among people aged 75 years or older (74 per cent) than among people under 65 (between 59 and 62 per cent).
• The three main reasons people gave for being satisfied with the NHS overall were: the quality of care, the fact that the NHS is free at the point of use, and the range of services and treatments available.
• The three main reasons that people gave for being dissatisfied with the health service were: long waiting times, staff shortages and lack of funding.

At a time when news headlines are dominated by a mounting sense of crisis across the health and social care system, the BSA survey provides an opportunity to step back and consider how public attitudes to the NHS compare to those in previous years.

In 2016, public satisfaction with ‘how the NHS runs nowadays’ was 63 per cent. The change in satisfaction from the previous year (when satisfaction was 60 per cent) was not statistically significant.

Dissatisfaction was 22 per cent in 2016, and the change since 2015 (when dissatisfaction was 23 per cent) was not statistically significant.

The BSA survey has been asking members of the public for their views on the NHS and its individual services since 1983. Figure 1 shows that since 2000, changes in public satisfaction can be split into three broad phases: ‘steady growth’ between 2002 and 2010, as satisfaction grew to an all-time peak of 70 per cent; ‘a sudden drop’ in 2011 when satisfaction fell by 12 percentage points, the biggest single-year drop in the survey’s history; and ‘little change’ between 2012 and 2016, over which time (except for 2014) annual changes in satisfaction have not been statistically significant.

This long-term view shows that in 2016, public satisfaction with the NHS was high by historic standards.

NHS satisfaction levels vary among different groups within the population. Figure 2 shows satisfaction rates split by recent contact with inpatient services, household income, gender and age. The black bars show the 95 per cent confidence intervals around each value, which are the range of values that, based on the survey data, we can be 95 per cent certain include the true satisfaction level for each group. Where the confidence intervals overlap, we cannot be confident that the true satisfaction levels differ between groups.

Respondents aged 75 and over reported higher levels of satisfaction (74 per cent) than those under the age of 65 (between 59 to 62 per cent). These differences are statistically significant.

There are only small differences between the rates of satisfaction reported by men and women, across income groups, and for those who have and haven’t had recent contact with inpatient services, and these differences are not statistically significant.

Satisfaction levels can also be influenced by political affiliation. People tend to report higher levels of satisfaction when the political party that they support is in power. This implies that satisfaction levels to some extent reflect people’s views on the government’s competence in running the service.

However, Figure 3 shows that in 2016 the highest levels of satisfaction were reported by supporters of the Liberal Democratic party (68 per cent). While there was a divergence in satisfaction levels between supporters of different political parties in 2015, levels converged in 2016, with no statistically significant difference in levels of satisfaction of Liberal Democrat, Conservative (66 per cent) and Labour (63 per cent) party supporters.

The survey also includes a set of questions that explore the public’s views on specific health and social care services. When interpreting this data, it is important to remember that this is a summary of the views of the public rather than of patients, and many respondents will not have recently used the particular service they have been asked to comment on. Because of this, the survey asks respondents to draw on ‘your own experience, or from what you have heard’, so the experiences of family and friends and information from other sources, such as newspapers, are likely to influence their responses.

Many of the survey respondents will have visited their general practice in the past year, either for themselves or with a family member. The public’s familiarity with this service, and the ongoing and (often) more personal nature of their relationship with their GP (compared with, for example, their relationship with the outpatient department of their local hospital) may be part of the reason why GP services consistently receive higher satisfaction ratings than other NHS services. In 2016, public satisfaction with GP services was 72 per cent. The change from 2015 (when satisfaction was 69 per cent) was not statistically significant.

Figure 4 shows that, for one year at least, this ends the downward trend in GP satisfaction ratings that has been evident in the survey since 2010.

NHS England’s national GP patient survey includes a similar question that provides a useful comparator for these results (‘Overall, how would you describe your experience of your GP surgery?’). For this measure, the trend over the past two years is similar to the BSA survey: the proportion of (English) respondents who rated their GP experience as ‘fairly’ or ‘very’ good remained steady throughout 2015 and 2016 at around 85 per cent.

NHS dentistry was the only service to see a statistically significant increase in levels of public satisfaction this year; at 61 per cent it was up 7 percentage points from 2015. This is one of the highest levels of public satisfaction with NHS dentistry services since the early 1990s. Figure 4 shows that there was a steep decline in public satisfaction with NHS dentistry services between 2000 (when satisfaction was 62 per cent) and 2004 (when satisfaction fell to 42 per cent). This may in part reflect difficulties people had in accessing services during that time, as changes to NHS payment rates led dentists to increase the amount of private work they undertook and decrease the amount of NHS work. Over the past decade, developments, including a focus by commissioners on increasing capacity, have led to significant improvements in access, and satisfaction has steadily increased.

The BSA survey defines social care services as personal support services provided by local authorities for people who cannot look after themselves because of illness, disability or age. In 2016, 26 per cent of respondents were satisfied with social care services, unchanged from 2015. For the past five years, public satisfaction with social care services has been considerably lower than it was a decade ago, when the question asked did not mention local authorities.

Compared to questions on NHS services, there is a higher proportion of ‘don’t know’ responses to the social care satisfaction question (12 per cent compared to 4 per cent for GP services). This may be because people are less familiar with social care services and are less likely to have had experience, either personal or through relatives or friends, of using them.

The BSA survey also asks respondents for their views on hospital-based services.

Public satisfaction with outpatient services was 68 per cent in 2016, and remains high by historic standards. The increase in satisfaction since 2015 (when 66 per cent were satisfied) was not statistically significant.

Satisfaction with inpatient services was 60 per cent in 2016, and there has been no statistically significant change for the past four years.

As with all other NHS hospital services in 2016, the change in public satisfaction with accident and emergency (A&E) services (54 per cent in 2016 compared to 53 per cent in 2015) was not statistically significant.

These steady trends over the past two years suggest public views of hospital-based services have not been negatively affected by the junior doctors’ strikes or media stories about NHS and social care funding and the pressures on services.

Figure 6 brings together public satisfaction data for health and social care services and the NHS overall in 2016. As in previous years, satisfaction with the social care services provided by local authorities was far lower than satisfaction with health care services. Social care was also the only service to have a negative net satisfaction score (calculated as satisfaction minus dissatisfaction) (Figure 7).

It is likely that the BSA survey’s measure of overall NHS satisfaction captures public views on a range of issues. To explore what lies behind this satisfaction rating, in 2015 and 2016 we included a follow-up question that asked respondents why they were either satisfied or dissatisfied with the NHS. The question presented people with nine possible reasons to explain their response and asked them to select up to three. These lists were developed with a small group of respondents who were asked an open-ended question about why they were either satisfied or dissatisfied.

Figure 9 shows that among the 63 per cent of respondents who were satisfied with the NHS in 2016, the most frequently cited reasons for this were: the quality of care (65 per cent), care being free at the point of use (59 per cent), and the range of services available (47 per cent).

Figure 8 shows that among the 22 per cent of respondents who were dissatisfied with the NHS in 2016, the most frequently cited reasons were: waiting times (54 per cent), a lack of staff (48 per cent), and a lack of funding (45 per cent). While the government not spending enough on the NHS was a factor for 45 per cent of those who were dissatisfied, there was also a sizeable group (32 per cent) who felt money is wasted in the NHS.

The five most frequently cited reasons for both satisfaction and dissatisfaction were unchanged from the previous year.

Very few respondents said their satisfaction rating was influenced by stories in the newspapers, on the radio or on TV. However, media sources may have had an indirect impact on satisfaction by influencing underlying attitudes. Self-reports of the impact of media stories on an individual’s attitudes are unlikely to pick up the full extent of media influence.

In 2016 the NHS remained popular with the public, far more so than it was 10 or 20 years ago. In particular, the public values a system that provides high-quality, comprehensive services that are free at the point of use.

Despite increasing pressure on hospitals and growing waiting lists, satisfaction with both outpatient and inpatient services remained steady. While the BSA survey measures public perceptions rather than user experience, the results show that these critical NHS services have managed to maintain public support in 2016. However, as the survey was conducted during the summer and autumn months, it does not pick up any change in public views that may have resulted from the intense pressure on the service this winter.

The most striking finding of the survey is the yawning gap between satisfaction with NHS and social care services. Public satisfaction with even the least popular NHS service (A&E) is more than double the level of satisfaction with social care. This result is unsurprising and is repeated every year that these questions have been asked. While this may in part reflect a lack of public understanding about what social care services are, the size of the gap suggests it may also reflect public views on disparities in both the funding of and entitlements to NHS and social care services.

The rich dataset provided by the BSA survey gives a different perspective on the current problems faced by the health and social care system. This long-term view reminds us that the NHS is popular with the public and has retained its reputation during turbulent times, but it also shows that the gulf between satisfaction with the services provided by the health system and by the social care system is wide and persistent. With social care services under huge pressure, this should focus the minds of politicians and policy-makers.