Public satisfaction with the NHS has fallen to its lowest level since 1997, according to analysis of the 2021 British Social Attitudes survey [BSA] published by The King’s Fund and the Nuffield Trust.
The survey, conducted by the National Centre for Social Research [NatCen] in September and October 2021, is seen as a gold standard measure of public attitudes. It finds that public satisfaction with how the health service runs has fallen sharply to 36 per cent – an unprecedented drop of 17 percentage points from 2020 and the lowest level of satisfaction recorded since 1997. Record falls in satisfaction were also seen across all individual NHS services, including GP and hospital services.
The fall in overall satisfaction with the NHS can be seen across all ages, income groups, sexes and supporters of different political parties. More people [41 per cent] are now dissatisfied with the NHS than satisfied. Concerns over long waiting times [65 per cent], NHS staff shortages [46 per cent] and inadequate government funding [40 per cent] remained the top reasons people gave for being dissatisfied with the NHS in 2021.
Despite this, support for the principles of the NHS is as strong as ever. The overwhelming majority of people expressed high levels of support for the founding principles of the NHS when asked if they should still apply in 2021: that it is free of charge when you need it [94 per cent], primarily funded through taxation [86 per cent] and available to everyone [84 per cent].
The think tanks’ analysis reveals that public satisfaction with GP services – historically the service with the highest levels of public satisfaction – has fallen by an unprecedented 30 percentage points since 2019 to 38 per cent, the lowest level of satisfaction recorded for GP services since the survey began in 1983. For the first time the number of people dissatisfied with GP services [42 per cent] is higher than those who are satisfied.
Levels of public satisfaction with hospital inpatient and outpatient services and dentistry are also all at the lowest level since the BSA survey began, and satisfaction with A&E services is at the lowest level since that question was introduced in 1999.
When asked what the most important priorities for the NHS should be, the top three cited by survey respondents were making it easier to get a GP appointment, improving waiting times for planned operations and increasing the number of staff in the NHS.
For the first time one of the founding principles of the NHS, that it is free at the point of use, was the top reason people are satisfied with the NHS [selected by 78 per cent of satisfied respondents], followed by the quality of NHS care [65 per cent] and that it has a good range of services [58 per cent].
80 per cent of people believed the NHS has a funding problem, the same as in 2019. As with previous years, the most popular option for any extra funding was for it to come from taxes, although the proportion of respondents choosing this option has declined slightly in recent years.
Satisfaction with social care remains far lower than satisfaction with NHS services. 15 per cent of respondents said they were satisfied with social care services in 2021, while 50 per cent were dissatisfied.
Dan Wellings, senior fellow at The King’s Fund said: “Our analysis reveals an unprecedented drop in public satisfaction with the NHS, which now stands at its lowest level in 25 years. People are often struggling to get the care they need and identified access to general practice, waiting times for hospital care and staff shortages as areas that need to improve. These issues have been exacerbated by the extraordinary events of the past two years but have been many years in the making following a decade-long funding squeeze and a workforce crisis that has been left unaddressed for far too long. Despite this, support for the founding principles of the NHS remains strong. The public do not seem to want a different model, they just want the one they have got to work.”
Professor John Appleby, director of research and chief economist at the Nuffield Trust, commented: “On top of the dramatic fall in overall public satisfaction with the NHS and care services, it is really very striking that we are seeing record low levels of satisfaction with individual health care services. The fall in satisfaction is widespread across all age groups and income groups, with political party support having no bearing. Against a backdrop of record waiting lists for surgery, disruption to services and difficulties getting appointments with a GP, people are concerned about what the NHS can deliver. We know that the NHS and social care services face a long and difficult journey to recover performance, and now public satisfaction is rapidly falling too.”
In response to the research, Matthew Taylor, chief executive of the NHS Confederation, has called for the public to be realistic about what the health service can deliver under current conditions, and for the government to avoid fuelling unrealistic expectation.
Taylor said: “We have been through a once in a generation pandemic that has rocked the NHS to its core and saw local services having to reprioritise their non-urgent care temporarily in response to coronavirus, and so sadly, it is of no surprise that this has had such a big impact on public satisfaction levels nationally.
“This will be deeply concerning for NHS leaders whose staff have done everything they can for their patients throughout the last two years against a multitude of challenges, including 110,000 vacancies, chronic underfunding, and outdated estates.
“The public has a right to expect high standards from the NHS, which is exactly what they get in the vast majority of interactions. However, these survey findings must be a wake-up call to the government to avoid inflating public expectations around what the NHS can deliver beyond the realms of reality.
“The NHS is springing back from the worst of the pandemic with independent data showing that teams are carrying out more diagnostic tests, GPs are seeing more patients than they were a year ago including face-to-face, and elective procedures are returning to pre-pandemic levels, but this is against a rising tide of growing patient demand for healthcare, workforce shortages, and uncertainty about how the threat of coronavirus will evolve over time.
“While the NHS welcomed its recent additional investment, it will take time to reconcile ten years of underinvestment, and it comes as NHS England has recognised that the combination of testing costs and the rising cost-of-living could potentially wipe £1.5 billion off the value of that settlement.
“The dedicated staff of the NHS are working flat out and making progress, but the consequence of demanding ever more from the service while denying it the tools it needs to do the job will only be further public disillusionment.”
Photo by Jonathan Borba on Unsplash
