tag:theconversation.com,2011:/id/topics/british-social-attitudes-2013-7103/articlesBritish Social Attitudes 2013 – The Conversation2014-01-07T00:03:25Ztag:theconversation.com,2011:article/217742014-01-07T00:03:25Z2014-01-07T00:03:25ZBehind the headlines, a nation divided over immigration<figure><img src="https://images.theconversation.com/files/38535/original/tmw69bkv-1389047354.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">How do you get in the taxi if you can't open the door?</span> <span class="attribution"><span class="source">kenjonbro</span></span></figcaption></figure><p>Immigration is seldom out of the news, but the past month has seen attention <a href="http://www.theguardian.com/news/reality-check/interactive/2014/jan/06/uk-migration-statistics-v-headlines">spike to new highs</a> as the removal of transitional controls on migration from Romania and Bulgaria has sparked furious debate. Many headlines suggest the British public is implacably opposed to migration, and demand radical action from the government to bring down migrant numbers. </p>
<p>The true picture, however, is more complicated, as revealed in data released today by the NatCen from the 2013 British Social Attitudes survey, which is the most comprehensive academic survey of <a href="http://www.bsa-29.natcen.ac.uk/about-bsa.aspx">British public attitudes</a>. </p>
<p>That the public believes migration levels are too high is indisputable: 77% of respondents said migration should be reduced, with 56% wanting it reduced by “a lot”. But it is important to put this number in context. Pollsters have been asking British people this question for almost exactly 50 years, and in practically every poll, a hefty majority of 60-85% report that <a href="http://www.migrationobservatory.ox.ac.uk/sites/files/migobs/Public%20Opinion-Overall%20Attitudes%20and%20Level%20of%20Concern.pdf">migration levels are too high</a>. </p>
<p>The proportion demanding reductions to migration was as large in the 1980s, when net migration was negative, as it is now, when net migration runs at 200,000 per year. So the British view of migration levels does not respond to the actual migration level; it is like a thermometer which says the temperature is “too hot” regardless of whether it is 30C or -10C. It is not clear what this measure actually captures, but it seems to be more like a general view of migrants in general rather than a response to current levels. Most voters regard migration as a bad thing to be avoided, so, just as any broccoli at all is “too much” for many children, any migration at all is “too much” for many voters. </p>
<p>We can dig a little deeper into British views about migration by moving the focus away from migration levels and towards migration impacts. The survey also asked respondents whether they thought the economic and cultural impact of migration had been positive or negative. Focusing on the effects of migration, rather than the number of migrants, reveals a very different picture. </p>
<p>Far from being a nation united in opposition to migration, Britain is instead a country evenly divided. In our 2013 data, 48% of Britons saw immigration as bad for the economy, while 52% saw it as neutral or good. The split on culture is similar: 46% seeing the cultural impact of migration as negative, and 54% regarding it as neutral or positive. Remarkably, given the harsh economic climate and the barrage of negative media attention, public perception of migration’s effects has improved somewhat since 2011. The proportion rating the economic impact as negative has dropped four points since 2011, while the proportion seeing a negative cultural impact is down two. </p>
<p>While the British public is evenly split over the impact of migration, attitudes are very polarised. The table below breaks down attitudes by economic circumstances and cultural factors, and reveals deep and enduring divides in views about immigration. </p>
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<p>The majority of respondents who are well off economically, who had some migrant heritage themselves (20% of our sample reported that they or one of their parents were migrants), those who went to university and those who report no prejudice against ethnic minorities are consistently positive about the economic and cultural effects of migration.</p>
<p>On the other side of the coin, economically struggling Britons, those with no migrant heritage, those with no formal educational qualifications and those who report some prejudice against ethnic minorities are strongly negative about the effects migration is having on the country. While the divides endure, it is also remarkable to see that the improvement in views about migration is reflected in every single social group, and that in many cases the biggest improvement comes from those with the most negative views. </p>
<p>A closer look at the underlying attitudes thus reveals that the headline picture of a British public passionately and implacably opposed to migration is a misleading caricature. Instead, we find a citizenry divided over the effects of a dramatic social change - while many dislike it intensely, many others see it positively. Far from turning against migration over the past two years of economic turmoil, Britons from all walks of life have become somewhat more positive about it. </p>
<p>The difficulty for politicians trying to craft policy in this area is that the importance different groups attach to immigration is not the same. Those who accept or welcome immigration do not regard it as a pressing issue, and rarely base their votes on it. For its opponents, though, migration has become an all encompassing issue, and a principle determinant of vote choice: <a href="http://www.ipsos-mori.com/researchpublications/publications/1634/Perceptions-and-Reality-Public-attitudes-to-immigration.aspx">in IPSOS-MORI’s regular polls</a>, more voters rate migration as one of the <a href="http://www.ipsos-mori.com/researchpublications/researcharchive/2420/Issues-Index-Archive.aspx?view=wide">top issues on the agenda</a> than any other issue except the economy, and almost all of these are opponents. It is no coincidence that Nigel Farage’s UKIP has <a href="https://theconversation.com/voters-havent-called-time-on-ukip-despite-some-poor-polls-16280">won its strongest support</a> from the very same groups the data reveals are most <a href="http://www.theguardian.com/commentisfree/2013/may/30/ukip-gunning-labour-ed-miliband">opposed to migration</a>. </p>
<p>This difference in intensity may explain the common misconception that the public is uniformly negative about immigration. The negative voices are heard more loudly, and more frequently, which leads many to conclude their views are more widespread than is in fact the case. This helps those with the most negative views to drive the political agenda. With universities, businesses and economic researchers worrying that the current government’s restrictions to migration may be economically harmful, perhaps the time has come for the silent, pragmatic majority to speak up.</p><img src="https://counter.theconversation.com/content/21774/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Robert Ford receives funding from Unbound Philanthropy, the Joseph Rowntree Foundation, the Joseph Rowntree Charitable Trust, the Fund for London, the Paul Hamlyn Foundation and the Diana, Princess of Wales Memorial Fund</span></em></p>Immigration is seldom out of the news, but the past month has seen attention spike to new highs as the removal of transitional controls on migration from Romania and Bulgaria has sparked furious debate…Robert Ford, Lecturer in Politics, University of ManchesterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/179672013-09-09T23:15:07Z2013-09-09T23:15:07ZGrowing support for Scottish independence … in England<figure><img src="https://images.theconversation.com/files/31011/original/5h5fmv7y-1378729701.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Popular south of the Border?</span> <span class="attribution"><span class="source"> David Cheskin/PA Wire</span></span></figcaption></figure><p>The introduction of devolution in Scotland and Wales and its re-introduction in Northern Ireland was one of the major achievements of the Labour government. Yet its aspirations for fostering devolution in England largely came to naught. </p>
<p>True, city-wide government for London, <a href="http://news.bbc.co.uk/onthisday/hi/dates/stories/march/31/newsid_2530000/2530803.stm">controversially abolished</a> by Mrs Thatcher in 1986, was <a href="http://news.bbc.co.uk/onthisday/hi/dates/stories/may/4/newsid_2503000/2503809.stm">restored in 2000</a> - but when, in 2004, voters in the north-east of England <a href="http://news.bbc.co.uk/1/hi/uk_politics/3984387.stm">rejected the idea</a> of having their own elected regional assembly, any hopes of rolling out a programme of devolution across the length and breadth of England died an instant death.</p>
<p>So has England simply been unmoved by the sight and sound of devolution elsewhere? Is it largely content with the way it is governed at present? And as Scotland prepares to vote in a year’s time on whether or not it should leave the UK entirely, is England really willing to tolerate what might be thought to be the ever increasing demands of its near northern neighbour? These are some of the questions addressed by a study of long-term trends in identities and constitutional preferences to be found in the latest <a href="http://www.bsa-30.natcen.ac.uk/">British Social Attitudes</a> report published today.</p>
<h2>Status quo (for England)</h2>
<p>England does indeed continue to evince relatively little interest in devolution for itself. Well over half, 56%, say that England’s laws should continue to be made by the UK parliament at Westminster. Although the figure has fluctuated up and down since 2000, there is no sign of a consistent trend in either direction. Just over one in five (22%) would like to see an English parliament established, while just 15% now back Labour’s original idea of regional assemblies. With figures like these, there seems little prospect of any government securing public support for changing the way England is governed any time soon.</p>
<p>Not that voters in England are entirely sanguine about some of the consequences of the fact that the rest of the UK enjoys a measure of devolution while it does not. Two-thirds say that now that many of Scotland’s laws are made by its own devolved parliament Scottish MPs should no longer be able to vote on laws that will only apply to England. </p>
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<p>True, that sentiment has been present since the very early days of devolution, but it seems to have become more insistent with as many as 29% now saying that they strongly agree with this proposition, up from 18% in 2000.</p>
<p>In short, voters in England would appear to think that the proper response to some of the apparent anomalies thrown up by the introduction of devolution elsewhere is to amend the way in which Westminster works rather than imitate the changes that have been introduced elsewhere. However, it remains to be seen whether there will eventually be a positive response to the ideas for changing Commons procedure on English bills put forward earlier this year by the <a href="http://webarchive.nationalarchives.gov.uk/20130403030652/http://tmc.independent.gov.uk/">MacKay Commission</a>.</p>
<h2>Pay own way</h2>
<p>England has also become less happy about the advantage in terms of public spending per head that Scotland continues to enjoy (albeit that is a state of affairs that long predates devolution). In the early years of devolution, only around one in five people in England felt that Scotland received more than its fair share of public spending, but since 2007 the figures have been consistently running at around twice that level.</p>
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<p>But if this discontent is not reflected in a demand that England should enjoy devolution itself, how is it expressing itself? The answer appears to be in a growing willingness to question whether Scotland should continue to have devolution for itself. In years immediately after the creation of the Scottish Parliament public opinion in England was remarkably sympathetic to the idea that its northern neighbour should enjoy a measure of autonomy, with up to 59% agreeing that devolution was the best way of governing Scotland. </p>
<h2>English backing independence</h2>
<p>Now, however, that figure has fallen to 43%. Meanwhile the proportion who think that perhaps Scotland should indeed leave the UK and become an independent country appears to have edged up from around a fifth to a quarter, while almost as many question whether there should be any kind of Scottish Parliament at all.</p>
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<a href="https://images.theconversation.com/files/31013/original/sv4kbkvb-1378733107.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/31013/original/sv4kbkvb-1378733107.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/31013/original/sv4kbkvb-1378733107.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=313&fit=crop&dpr=1 600w, https://images.theconversation.com/files/31013/original/sv4kbkvb-1378733107.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=313&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/31013/original/sv4kbkvb-1378733107.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=313&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/31013/original/sv4kbkvb-1378733107.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=393&fit=crop&dpr=1 754w, https://images.theconversation.com/files/31013/original/sv4kbkvb-1378733107.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=393&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/31013/original/sv4kbkvb-1378733107.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=393&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<p>At the moment most <a href="http://whatscotlandthinks.org/questions/should-scotland-be-an-independent-country-1#line">opinion polls</a> suggest that in fact Scotland will vote to stay in the UK. Yet, at the same time, not only does almost everyone in Scotland want to keep their parliament, but a majority say they would like their parliament to be even more powerful than it is already. </p>
<p>At first glance that would seem to be recipe for a potential clash with opinion in England. However, one consequence of such a move could well be that Scotland has to rely more on revenues raised by taxes in Scotland itself rather than on monies handed over by taxpayers from across the UK. Maybe such a step is now just as necessary to assuage English discontent as it is to meet Scottish aspirations?</p><img src="https://counter.theconversation.com/content/17967/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Curtice is co-editor of the British Social Attitudes 30th report. Partial funding for the 2012 Scottish Social Attitudes data reported here was generously provided by the Economic and Social Research Council (grant number ES/K006355/1) and the Electoral Reform Society. Funding for the 2012 Northern Ireland Life and Times data was provided by the Office of the First Minister and Deputy First Minister, and by ARK. Funding for the 2012 British Social Attitudes data came from NatCen Social Research’s own resources. Responsibility for the views expressed lies solely with the authors. </span></em></p>The introduction of devolution in Scotland and Wales and its re-introduction in Northern Ireland was one of the major achievements of the Labour government. Yet its aspirations for fostering devolution…John Curtice, Professor in Politics, University of Strathclyde Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/180202013-09-09T23:10:20Z2013-09-09T23:10:20ZBritons say no to smaller state<figure><img src="https://images.theconversation.com/files/31019/original/5gyc6ygn-1378737422.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Representing the 90%.</span> <span class="attribution"><span class="source">Dave Thompson/PA</span></span></figcaption></figure><p>Britain is still a majority social-democratic country. That is, politically, the most significant finding of the latest <a href="http://www.bsa-30.natcen.ac.uk/">British Social Attitudes survey</a> published this week. Most people want a country which “gets and spends” about what we do now, or even more, rather than less. The BSA figures seem to contradict the often heard assertion that the British people want Scandinavian levels of public services for American levels of taxes.</p>
<p>How do we judge how “social” democrat, as opposed to “liberal” democrat, a country is? The most telling test is how much people are willing to have collected in taxes and spent on public services and welfare provision.</p>
<p>Britain, for the past 50 years or more, has lain somewhere in the mid-Atlantic in terms of actual tax and spend. Our average spend, as a percentage of GDP, has been just under 43% – roughly midway between American and continental European levels.</p>
<p>The supposedly radical, “rolling back the state”, government of 1979-97 managed to “roll back” public spending to an average of 43.5% - very slightly up on the long-term average.</p>
<p>The “high-spending” New Labour government of 1997-2010 was nothing of the sort, seen in this historical perspective, at least until the onset of the Global Financial Crisis and “Great Recession” in 2008. Gordon Brown actually managed to get public spending down to its lowest level in the past five decades – below 37% of GDP – in 1998. Labour’s average, even including the GFC impact, was only 40% of GDP, and had stabilised at about 41% of GDP, just below the long-term trend rate before the GFC hit.</p>
<p>The British Social Attitudes Survey data go a long way to explaining this trend. Since 1983 they have been asking the same question every year - given a choice between these three options, which would you choose:</p>
<ul>
<li><p>Reduce taxes and spend less on health, education and social benefits</p></li>
<li><p>Keep taxes and spending on these services at the same level as now</p></li>
<li><p>Increase taxes and spend more on health, education and social benefits</p></li>
</ul>
<p>Throughout this period the “smaller state” option has never risen above 10%, with around 90% preferring the state to remain the same size or even grow.</p>
<p>Some voices on the right of British politics have been calling for “American” levels of tax and spend (about a third of GDP) since the 1970s. Think tanks on the right, like the Adam Smith Institute, <a href="https://theconversation.com/quackademics-under-fire-as-critical-voices-targeted-17381">Institute for Economic Affairs</a> and more recently Reform have been banging on about this for years – and in more recent years they have been joined by the “Orange Book” Liberal Democrats.</p>
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<span class="caption">Attitudes to tax and spend, 1983–2012.</span>
<span class="attribution"><span class="source">British Social Attitudes Survey 2013</span></span>
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<p>The BSA figures help to explain why advocates of this radical right, “liberal democratic state”, position have failed to get anywhere near achieving their goal: the political obstacles are enormous. And in any case, public spending at these sorts of levels is now so embedded in the economic fabric that any radical reduction would have very disruptive effects on both public and private sectors.</p>
<p>The real fluctuation – as the BSA figures show – has been between the state should stay about the “same” size, or that it should get bigger (the “more” option).</p>
<p>The BSA analysts suggest that this fluctuation is “thermostatically” linked to changes in fiscal trends; when the state was perceived as getting “too small” in the late 80s and early 1990s, the tax and spend more group grew.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/31003/original/kxjskpx8-1378719651.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/31003/original/kxjskpx8-1378719651.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/31003/original/kxjskpx8-1378719651.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=272&fit=crop&dpr=1 600w, https://images.theconversation.com/files/31003/original/kxjskpx8-1378719651.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=272&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/31003/original/kxjskpx8-1378719651.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=272&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/31003/original/kxjskpx8-1378719651.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=341&fit=crop&dpr=1 754w, https://images.theconversation.com/files/31003/original/kxjskpx8-1378719651.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=341&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/31003/original/kxjskpx8-1378719651.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=341&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Long-term Public Spending Trends (% GDP)</span>
<span class="attribution"><span class="source">HMT</span></span>
</figcaption>
</figure>
<p>By the mid-2000s, after New Labour’s rapid rise in public spending between 2000 and 2005, the “same” and “more” scores reversed. Now over 50% wanted tax and spend stabilised, and that is in fact what happened in the 2004 Spending Review.</p>
<p>Of course there have also been important other shifts in public opinion suggest. Welfare, and especially unemployment, benefits have become markedly less popular when people are asked specifically about them. But overall there has clearly been no dramatic shift to a “smaller state” attitude amongst the British public, however much the current coalition government might wish it otherwise.</p><img src="https://counter.theconversation.com/content/18020/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Colin Talbot does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Britain is still a majority social-democratic country. That is, politically, the most significant finding of the latest British Social Attitudes survey published this week. Most people want a country which…Colin Talbot, Professor of Government, University of ManchesterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/180172013-09-09T23:06:26Z2013-09-09T23:06:26ZBritish attitude to the NHS – quite satisfied, actually<figure><img src="https://images.theconversation.com/files/31029/original/jyccgq9g-1378744739.jpg?ixlib=rb-1.1.0&rect=0%2C4%2C996%2C665&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Patients are more likely to complain about food than treatment.</span> <span class="attribution"><span class="source">A hobo dancing barefoot</span></span></figcaption></figure><p>The NHS in the UK has come in for a lot of bashing of late, especially from politicians and the media. The former do so for largely ideological reasons, while I fear the latter often report the exceptions that sell papers. </p>
<p>We mustn’t forget that there are about a million NHS consultations every day. The overwhelming majority of these are of good quality, even if they don’t necessary give desired news to the patient. And despite the efforts of the media and politicians, most of us are generally happy with the way the NHS operates. </p>
<p>The <a href="http://www.bsa-30.natcen.ac.uk/">British Social Attitudes report</a>, published today, shows exactly that. There have been some changes over the past three decades, but we are generally satisfied with the NHS.</p>
<h2>What is ‘satisfaction’?</h2>
<p>A common sense definition of satisfaction is “a judgement about whether expectations have been met”. But a recent Health Technology Assessment <a href="http://www.hta.ac.uk/fullmono/mon632.pdf">review</a> suggests that this common sense understanding is too simple.</p>
<p>If meeting expectation is the key, we could increase satisfaction in two major ways: either meet people’s expectations by offering better services or lower people’s expectations. </p>
<p>But patient satisfaction is actually more complex. It’s influenced by other factors such as the actual standards of care received; expectations; patients’ dispositions; time passed since care took place and previous experiences. </p>
<p>Together with colleagues I’ve <a href="http://www.ncbi.nlm.nih.gov/pubmed/12752163">previously argued</a> that patients often cannot assess the quality of the care they receive; they suffer from the dilemma that “what is, must be best”. In other words, the drugs or treatment prescribed by the doctor must be good because they prescribed it. Patients are more likely to assess the hospital where they received treatment on its parking facilities, food or visiting times, rather than their treatment.</p>
<h2>Older people happier</h2>
<p>The British Social Attitudes Report’s headlines are that public satisfaction with the NHS is higher now than it has been for most of the past three decades. To be precise, 61% were satisfied with the NHS in 2012, compared with only 34% in 1997 and a peak of 70% in 2010. The report authors remind us that not all parts of the NHS do equally well, since in-patient care scores lower than community care including general practice. </p>
<p>Another headline is that older people (aged 75 and over) are more satisfied than their younger counterparts; 75% of the over 75s versus 63% of those aged between 18 and 24.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/31012/original/n5syq5bq-1378732221.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/31012/original/n5syq5bq-1378732221.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/31012/original/n5syq5bq-1378732221.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/31012/original/n5syq5bq-1378732221.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/31012/original/n5syq5bq-1378732221.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/31012/original/n5syq5bq-1378732221.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/31012/original/n5syq5bq-1378732221.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">NatCen</span></span>
</figcaption>
</figure>
<p>Today’s tabloid newspapers and the two-minutes piece on TV news channels no doubt highlights the headline findings of the report. There won’t be much space to look into some of the more sophisticated explanations provided by the authors of the variations in the trends in satisfaction levels. </p>
<p>For example, the survey authors have looked at the correlation between satisfaction levels and people’s political affiliation. Are party members of the ruling party (or parties in the current coalition government) more satisfied with the NHS than those whose party isn’t in power? </p>
<p>The statistics suggest that during the time Labour was in power (1997–2010) Labour supporters’ satisfaction tended to be higher than that of Conservative or Liberal Democrats. However, in the previous period (1983-1996) when the Tories were in power Conservative voters were more satisfied with the NHS than Labour or Liberal supporters. </p>
<p>The report concludes that over the past three decades the views of the Labour Party and Liberal Democrat supporters have been quite similar, much more so than the views of Labour and Conservative supporters.</p>
<p>Another headline finding worthy of further investigation is age. Over the past 30 years the proportion of people aged 75 and over who expressed satisfaction with the NHS was 15-25% higher than the proportion of 18 to 24 year olds who thought the same. The authors’ explanation includes the factor that older people are more frequent users of NHS services, and that NHS users are more likely to be satisfied with the NHS that non-users. </p>
<p>An often used argument is that the age difference in the levels of satisfaction reflects younger people’s higher expectations of the NHS, which makes them harder to satisfy than their parent or grandparents. Interestingly, a recent <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3618164/pdf/JRSM-12-0147.pdf">study</a> by Bowling and colleagues in the Journal of the Royal Society of Medicine suggested this might not be the case. Instead, they argue that older patients are more satisfied with their care not because their expectations are lower, but older people believe that their high expectations are generally being met. </p>
<h2>Link to quality?</h2>
<p>It’s clear that satisfaction is a multi-dimensional concept determined by a variety of factors. Many scholars have commented that many satisfaction studies lack a conceptual or theoretical basis. They argue that (a) satisfaction studies shouldn’t be used to allocate resources, and (b) patients are unlikely to evaluate care in terms of satisfaction. </p>
<p>Without identifying the theoretical foundation of the concept of (patient) satisfaction it is debatable how we can link it usefully to the quality of the services provided. However, these academic considerations won’t stop hospital managers, politicians and the media using satisfaction studies.</p>
<p>The state-funded health care system that is the NHS is one of the best in the world so I’m not surprised that satisfaction levels are generally high - despite what the media and many right-wing politicians want us to believe.</p><img src="https://counter.theconversation.com/content/18017/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Edwin van Teijlingen has received funding relevant to this paper in the past from the Chief Scientist Office of the Scottish Government and NHS R&D Technology Assessment(HTA) Programme.
He is a member of NHS NIHR Research for Patient Benefit Committee (RfPB) for the South West Region for thhe period 2010-2014.</span></em></p>The NHS in the UK has come in for a lot of bashing of late, especially from politicians and the media. The former do so for largely ideological reasons, while I fear the latter often report the exceptions…Edwin van Teijlingen, Professor of Reproductive Health Research, Bournemouth UniversityLicensed as Creative Commons – attribution, no derivatives.