A long way back: public satisfaction with health and care services at record lows

The latest British Social Attitudes (BSA) survey, carried out in 2022, tells a sorry tale of public satisfaction with health and care services. From a peak of 70% in 2010, overall satisfaction with the NHS has fallen to just 29% – the lowest figure recorded since this question was first asked in 1983. Satisfaction with individual NHS services is at record lows across the board, while satisfaction with social care is the lowest of all with only 14% of the public saying they are satisfied with it.

The previous year (2021) saw the largest fall in overall satisfaction with the NHS in the history of the survey, falling 17 percentage points in one year. While the seven percentage point fall this year is not as dramatic, it is still the fourth-largest year-on-year fall in the history of the survey. The mood appears to have turned from sudden shock to durable dismay at the state of health and care services in this country. At the same time, though, public commitment to the core principles of a health service free at the point of need, available to all and primarily funded through taxation remains undimmed.

Urgent concern

A striking finding from the last survey was a collapse in satisfaction with general practice – falling 30 percentage points from 2019 to 2021 to 38%, its lowest level ever recorded. Satisfaction with general practice has fallen again in 2022 to 35%, but the rate of decline has slowed.

In the 2022 BSA, it is satisfaction with accident and emergency services which has seen the sharpest fall, with just 30% saying they are satisfied with A&E, and 40% saying they are dissatisfied. Last year, 39% were satisfied, comfortably above the proportion dissatisfied, and as recently as 2019 satisfaction with A&E services was at 54%.  

It is not difficult to understand what may have sparked this fall. While waiting times targets for A&E have been missed consistently since 2014, there was a sharp decline in performance between 2021 and 2022, and indicators suggest a system where performance is declining in places to levels which were previously unthinkable. In October 2021 (when fieldwork for the 2021 BSA ended), 7,000 patients in a month had waited more than 12 hours in England to be admitted from A&E after doctors decided they required a hospital bed. By October 2022, that had risen to 44,000. The number of long waits in A&E has been deteriorating for several years. Last autumn, when the survey was in the field, more than 500,000 people each month were experiencing waits longer than the target time of four hours.

Respondents may also have been reflecting the alarming difficulties facing the ambulance service last year. In October 2022, average response times in England for a ‘category 2’ call-out – often a stroke or heart attack – stretched to more than an hour. The target is just 18 minutes.

Healthwatch England, which gathers and voices public feedback, saw a striking acceleration in the amount of feedback they received on urgent and emergency care services in the months leading up to our fieldwork.

Social care

While the picture on satisfaction with the NHS is bleak, the story on social care is even worse. The results this year show a clear deterioration from a position that was already very poor, with a significant increase from 50% dissatisfied up to 57%. Only 14% of people said they were satisfied with social care. Disturbingly, and bucking a pattern seen elsewhere, people who had contact with social care were even more likely to be dissatisfied than those who had not. The most common reason given for dissatisfaction was “People don’t get all the social care they need”, chosen by 64%, followed by poor pay and conditions for staff.

These closely reflect the problems that the Nuffield Trust, The King’s Fund and bodies representing the sector and those using services would identify. Social care has traditionally not had the prominence of the NHS in public debate, but these results suggest concern is growing.

What do people think needs to happen to fix the NHS?

The public see lack of funding and lack of staff as key reasons for the state of the NHS. 50% of those who were dissatisfied attributed this to government spending levels, and 55% to inadequate staffing. Concern about funding shows up strongly in other questions as well, and these same issues have come up in survey after survey on the NHS in the last few years.  

What there is not, however, is any sign of the public overall reconsidering the founding principles of the NHS. Each of these – tax funding, a universal service, and being free at the point of use – enjoys overwhelming support with no statistically significant change from last year.

When asked what should be the most important priorities for the NHS, improving waiting times for A&E saw a sharp increase from last year, with staffing and waiting times remaining high on the agenda.

However, action on health inequalities remains relatively low on the list and interest in preventing ill health has dropped significantly as a priority. A difficult message might be that if forced to choose, the public want the NHS to be delivering the basics before it can expand its role into areas like these. Yet inequalities and poor public health themselves determine the level of demand that affects waiting times. Politicians and leaders in the system will need to be ready to make the case, convince and lead if they want to persuade the public to recognise the importance of these issues and the effect they could have on the future sustainability of the NHS.

Political implications

The intensity of public feeling about the NHS makes it central to British politics: the public have told pollsters that it has been one of the top issues facing the country for over a decade, and it remains the country’s greatest source of pride. The current mood is that the service is poorly run, understaffed, and failing to deliver what people expect.

Yet none of this translates into any appetite for user charging or a different funding model, which are the first options that some commentators flailing around for a magical solution tend to clutch at. The public’s aspirations seem straightforward: they simply want an NHS which does what it says on the tin and which works. They were highly satisfied with a system which provided this as recently as 12 years ago, and they do not accept that this is too much to ask. As we begin to enter the run-up to another general election, these results send a firm instruction to the UK’s political leaders to begin the long road back to delivering what is expected.

Mark Dayan is a Policy Analyst and Head of Public Affairs at the Nuffield Trust, and Dan Wellings is a Senior Fellow at the King’s Fund. They are both authors of new analysis published today on public satisfaction with the NHS and social care, based on the 2022 British Social Attitudes survey.