Feature Databriefing

How satisfied are we with the NHS?

BMJ 2011; 342 doi: http://dx.doi.org/10.1136/bmj.d1836 (Published 22 March 2011) Cite this as: BMJ 2011;342:d1836
  1. John Appleby, chief economist
  1. 1King’s Fund, London W1G 0AN, UK
  1. j.appleby{at}kingsfund.org.uk

More members of the British public than ever believe that the NHS is doing a good job, according to data analysed here by John Appleby. Which raises the question of why the government finds it lacking and is pushing for urgent change?

The NHS may be, in the words of Nigel Lawson, “the closest thing the English have to a religion” (adding for good measure, “with those who practice in it regarding themselves as a priesthood”1), but are we satisfied with it (and the priesthood)?

The longest running survey of public satisfaction with the NHS is the British Social Attitudes (BSA) survey.2 The first survey was conducted in 1983. With the exception of three years, it has, among a host of questions about the public’s attitudes to everything from litter to crime, a continuous run of identical questions about satisfaction with the NHS. The nature of its sampling method makes for valid comparisons between years.

Interpreting responses (and their trends) to questions about satisfaction (with anything, not just the NHS) can be difficult as replies will in part depend on respondents’ expectations—some people may be more easily satisfied than others, and expectations for everyone may change over time. Nonetheless, surveys such as the BSA provide a useful indicator of the public’s general views about the NHS and its services.

The latest BSA survey reports that 64% of the British public are either very or quite satisfied with the NHS—the highest level of satisfaction since the survey began, and part of a continuous upward trend since 2002 (see fig A in extra material on bmj.com).3

As for Lawson’s “priesthood,” satisfaction with general practitioners has now reached 80%—3% short of its highest level in the early 1990s—but for dentists satisfaction fell over the decade to 2009 from 53% to 48% (see fig B on bmj.com). Satisfaction with inpatient services also fell—by one percentage point—over the same period, although it has risen year on year since 2006, after a long decline since 1983. But the public now seems much more satisfied with outpatient and accident and emergency services than in 1999.

Analysis of the BSA question about general satisfaction with the NHS by the political parties that respondents say they identify with (though not necessarily vote for) shows a perhaps expected gap between Conservative and Labour: those identifying with Labour being less satisfied during times of Conservative governments (1983–97) than Conservatives, and vice versa in times of Labour administrations (1997–2009). But it seems that the rising satisfaction with the NHS over the past 10 years or so has also been shared by Conservatives, whose satisfaction is also now the highest since the survey began (fig C on bmj.com).

Improvements in satisfaction are inversely mirrored by Ipsos-Mori’s monthly polling of the “most important issues facing Britain today.”4 From the turn of the century, when around seven out of 10 people said it was an “issue,” the number of people concerned about the NHS fell to a low of just over one in 10 in 2009 and, most recently, one in five this year (fig D on bmj.com). Worries about the economy, on the other hand, dramatically reflect the global banking crisis and ensuing recession.

Leaving aside the unlikely explanation that expectations have been taking a dive over the past decade, the NHS must have been doing something right to earn this extra satisfaction—something even Conservative supporters have noticed—and something probably not unadjacent to the large rise in funding since 2000. Future BSA surveys will reveal how satisfied the public remain as funding for the NHS is squeezed and the government’s proposed reforms take shape on the ground.

Notes

Cite this as: BMJ 2011;342:d1836

Footnotes

  • Competing interests: The author has completed the unified competing interest form at www.icmje.org/coi_disclosure.pdf (available on request from him) and declares: no support from any organisation for the submitted work; no financial relationships with any organisation that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.

  • Provenance and peer review: Commissioned; not externally peer reviewed

References