WIREDGOV

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 today by The King’s Fund and the Nuffield Trust.

The survey (1) carried out 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 (2) 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) remain 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 (3): 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 (4), 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 are 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, is 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 believe the NHS has a funding problem, the same as in 2019. As with previous years, the most popular option for any extra funding is 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 are satisfied with social care services in 2021, while 50 per cent are 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, said: ‘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.’

1. Since 1983, the National Centre for Social Research’s (NatCen) British Social Attitudes (BSA) survey has asked members of the public across England, Scotland, and Wales about their views on health and care services. The latest survey was carried out between 16 September and 31 October 2021 and asked a nationally representative sample of 3,112 people about their satisfaction with the NHS overall, and 1,039 people about their satisfaction with specific NHS and social care services as well as their views on NHS funding and principles. The King’s Fund and The Nuffield Trust sponsor these health questions and summarise the headline health results. NatCen will publish further results from BSA in the autumn. 
2. The main question asked was ‘All in all, how satisfied or dissatisfied would you say you are with the way in which the National Health Service runs nowadays?’ and the response options were ‘very satisfied’, ‘quite satisfied’, ‘neither satisfied nor dissatisfied’, ‘quite dissatisfied’ and ‘very dissatisfied’. Satisfaction as reported here aggregates those who answer 'very' and 'quite' satisfied. 
3. In 2021 new questions were added to the survey asking people their views on what the priorities for the NHS should be and the extent to which they think the founding principles of the NHS should still apply.
4. The GP satisfaction measure is the closest the survey gets to a measure based on direct personal experience, as most people will have visited their GP in the past year for either themselves or a family member. In 2021, 86 per cent of people surveyed had used or had contact with general practice in the previous 12 months.
5. The survey methodology is based on a randomly selected sample of the British public. It includes those who had recent contact with the NHS and those who had not. From 1983 until 2019 the survey was conducted face to face. This method was no longer possible in 2020 due to Covid-19 social distancing rules and that year the BSA survey was conducted primarily online with a telephone option available. This method continued in 2021. The 2021 data has been carefully weighted to minimise any risk that differences in attitudes after 2020 are a consequence change of methodology and we can be confident in making comparisons between years.  The order in which questions on the NHS are asked has not changed in recent years.
6. The analysis of the BSA health results was carried out by Dan Wellings, Danielle Jefferies, David Maguire, John Appleby, Nina Hemmings, Jessica Morris and Laura Schlepper. It will be published on both The King’s Fund and the Nuffield Trust is avail, with available here.  Previous survey reports can be viewed here: https://www.kingsfund.org.uk/projects/public-satisfaction-nhs
7. The King’s Fund is an independent charity working to improve health and care in England.
8. The Nuffield Trust is an independent think tank aiming to improve the quality of health care in the UK by providing evidence-based research and policy analysis.
9. The National Centre for Social Research, Britain’s largest independent social research organisation, aims to make life better through high quality social research (www.natcen.ac.uk). 

Public satisfaction with the NHS and social care in 2021: Results from the British Social Attitudes survey