Public satisfaction with NHS at second-highest level in 30 years – but are we really happier?

On the up. Satisfaction by Shutterstock

New data published today from NatCen’s British Social Attitudes (BSA) survey reveals an increase in satisfaction with the NHS – up to 65% from 60% in 2013. At the same time, dissatisfaction is at its lowest level since the survey began 30 years ago, at just 15%.

This might seem counter-intuitive; if you’ve read a newspaper in recent weeks, with the pressure on A&E services over the winter a recurrent theme, you might find it hard to believe that people are more satisfied with the NHS than in the past. So it’s interesting to think about what might be driving this change.

The facts

Two thirds of the public (65%) said they were quite or very satisfied with the NHS. This is the second-highest NHS satisfaction level recorded on the BSA, five points lower than a record level of satisfaction in 2010 and higher than all other readings since the coalition government took power. And it is far higher than the satisfaction levels recorded during the 1990s and early noughties.

NatCen British Social Attitudes, Author provided

So what’s going on? We can look more closely at the data and make some educated guesses about why satisfaction has risen, but we don’t know for sure. What we might be seeing is a straightforward increase in satisfaction with the NHS. Perhaps people’s overall experiences of the health service in 2014 were simply better than they were in previous years and this led them to say they were more satisfied.

However, as a measure, “satisfaction” can capture more than simply views about the quality of the service. As the BSA is a general population survey, many of the people we speak to haven’t had recent experience of the NHS, and so have formed an opinion based on their perception of the health service.

Health reforms

It’s useful therefore to think about public attitudes in the current political context. There was a big fall in satisfaction with the NHS in 2011, following an all-time high in 2010. At the time we speculated that one of the major factors behind the drop was anxiety about the government’s far-reaching reforms of the NHS introduced by then health secretary, Andrew Lansley.

This increase in satisfaction could represent an endorsement of these changes, or perhaps, with discussion of the reforms having faded over time, the public’s concerns have faded too.

So how do opinions differ between those who have had recent contact with the NHS and those who haven’t?

In 2012 and 2013, people who had direct experience of the NHS (as an inpatient) tended to be more satisfied with the NHS than those who had none. However this gap has now closed significantly. In 2014 there was an 11 percentage point increase in satisfaction among those with no personal NHS contact, much bigger than the four percentage point increase among those with recent contact.

So it is people without first-hand experience of the NHS who have become more positive about it. We could speculate that this group might be more influenced by the media and political agenda than those who can base their views on personal experience. This would mean that the disappearance of health reforms from the front pages is a possible explanation for the change rather than improvements in the health service itself.

Party politics

We also found that the increase in satisfaction was most pronounced among Labour Party supporters. There was an 11 point increase in levels of satisfaction among Labour supporters since 2013. This closed the gap between party supporters, when satisfaction was higher among Conservative than Labour supporters.

NatCen British Social Attitudes, Author provided

It seems unlikely that this jump is because more Labour supporters think that the NHS is working better. One possible explanation is that this increase is an expression of support for the NHS at a time when it is facing some difficulties and financial pressures.

What about individual services?

Looking at individual services within the NHS, satisfaction was highest for GPs (71%) and outpatient services (69%), followed by inpatient care (59%), A&E (58%) and dentistry (54%).

NatCen British Social Attitudes, Author provided

Although people are most satisfied with GP services, this year is the lowest satisfaction level we have seen since we first asked the question. Satisfaction in GPs has been decreasing since 2009 when 80% were satisfied. So the rise in satisfaction with the NHS is not across the board.

Implications for the election

In the run-up to the general election in May, these findings take on extra importance. We know from more than 30 years of asking the public that health has always been, and remains, the public’s top priority for government spending.

The partial reversal of the drop in satisfaction that accompanied the early days of the coalition is no doubt good for the Conservatives’ and Liberal Democrats’ credentials as custodians of the health service. However, the Labour Party can also take some comfort from the possibility that this rise may be more about their own supporters underlining their fondness for the NHS than the public being pleased with the way the health service is being run.