40 years of the British Social Attitudes Survey

Since 1983, the British Social Attitudes Survey (BSA) – run by the National Centre for Social Research (NatCen) – has polled a sample of the public to track their views about everything from abortion, litter, public spending, taxation, the NHS… There is hardly a topic or issue about our lives that hasn’t been addressed by the survey.

Over the years and through consistent questions, it has recorded some notable trends in our views. In 1983, for example, just 17% of the public thought same-sex relationships were “not wrong at all”. By 2018, that proportion had increased to 66%. On capital punishment, the survey has tracked a steady decline in support – from 75% in 1986 to 43% in 2020. For some issues, however, it’s not changes that are interesting but continuity too. The proportion of those surveyed who agree that “ordinary working people do not get their fair share of the nation’s wealth” has remained pretty stable at around 60% since 1986.

These sorts of trends are not just of passing interest about how our attitudes change (or stay the same). They provide insights for policy-makers into how policies or priorities might need to change. They can also provide a verdict on the government’s perceived performance and current policy too. For example, the long-running question on satisfaction with the NHS has proved to be a pretty accurate – and, every now and then, startling – barometer of how the public feels about its health service.

Satisfaction with health and care services at record lows

The latest (2022) results reveal an historically deep dissatisfaction with the way the NHS is run nowadays. The proportion satisfied with the NHS (29%) is the lowest since the survey began, and the proportion dissatisfied (51%) the highest. This plummet in satisfaction is reflected across NHS services such as general practice, A&E, dentistry, outpatients and inpatients, as well as with social care. These sorts of changes in attitudes are hard to ignore and will give politicians and ministers pause for thought.

Quite what those thoughts should be are also helped by the BSA. While “satisfaction with the NHS” has been asked since 1983, getting some insights into why people were either satisfied (or perhaps more usefully) dissatisfied has been difficult. But since 2015 the BSA has also asked for the underlying reasons for answers to the satisfaction question. “Waiting too long for a GP or hospital appointment” has consistently topped the reasons for dissatisfaction – increasing from 55% in 2015 to a peak of nearly 70% in 2022. These results are reinforced when the public are asked about priorities for the NHS; waiting times again dominate.

Given rising waiting list numbers over the last decade (and the pandemic’s unwelcome boost) this shouldn’t come as news to the NHS or ministers. But it confirms that, for the public, fixing waiting times is a priority. As Labour governments in the early part of the century found, as waiting lists and times started to reduce, satisfaction increased.

Over the years, the BSA has developed its health care section from a core set of NHS satisfaction questions to explore private health insurance, patient choice, rationing, perceptions of past and future improvement in the NHS, health care priorities, views on mental health problems, attitudes towards one’s own health, NHS funding, the founding principles of the NHS and more.

Unlike, perhaps, the unsurprising recent findings that people are discontented about waiting times, the 2004 BSA found that around two-thirds were in favour of more choice over which hospital they go to. And while satisfaction with the NHS has plunged again in 2022, the survey reveals that this is not associated with any erosion in support for the NHS to be available free at the time of use, available to all and funded through taxation.

As important as ever

In an increasingly crowded polling field, the BSA remains a key source of continuity and change in the public’s views. In particular, attitudes towards the NHS and social care – as with the latest results from the BSA – not only reflect the public’s main concerns about their lives, but are widely reported. As such, they provide an invaluable input to public policy-making and will remain vital in future.

*Read the latest analysis of the BSA survey, which shows that satisfaction with the NHS and social care dropped to new lows in 2022.

All the data collected by the BSA – not just the health care questions sponsored by the Nuffield Trust and the King’s Fund – are publicly available via the UK Data Service and NatCen’s BSA website.