Glimmers of light but no new dawn in public satisfaction with the NHS

This year’s responses to the annual British Social Attitudes survey on the NHS and social care are as complex to interpret as they are hopeful. A significant six percentage point increase and the biggest fall in dissatisfaction in a quarter of a century are, without a doubt, positive and encouraging results. It is right to greet them with relief, hope and a degree of optimism. 

But the results don’t offer a clear indication of why the public are more satisfied. Unlike in recent years, significant changes in NHS satisfaction haven’t been accompanied by changes in satisfaction with services. In fact, any year-on-year change within NHS services was not statistically significant. 

Furthermore, optimism that care will get better is lower than at any point in the past. And the overall NHS result, while notably better than previous years, still shows that just over one in four people are satisfied – the third lowest score in the survey’s 42-year history. Hardly the heights of satisfaction we saw in the early 2010s. Satisfaction with social care remains at an appalling 14%. 

So, what is going on? Can government claim – as it surely will – that this result shows that its reforms are already working? It is true that there are some signs of clear progress that would have meant that a continued fall in satisfaction would have felt unfair: patient experience surveys show small signs of improvement; waiting lists have stabilised; productivity has begun to improve. 

But these changes are perhaps less the result of the government achieving some kind of sudden change in the NHS, and more the result of its presiding over a continued slow, steady recovery. The former NHS England Chief Executive Amanda Pritchard warned in 2023 that clearing the backlog created by the pandemic could take up to five years. 

Progress, in other words, was always likely to come through gradual improvement rather than dramatic change. For policymakers, the message is clear: things are looking up, but from a low base. Malaise is widespread. Divisions – between younger and older respondents, and those supporting the range of political parties now established in our politics – pose real challenges for the future. And optimism is low. 

Britain is a country where trust in government and faith in the economy have fallen to disturbingly low levels, yet this survey shows that people still overwhelmingly support the NHS’s founding principles. The challenge ahead is whether or not the NHS can also regain the public’s support in how well it is run. 

What is much less clear, amid our divided politics and fragile economy, is whether the sorts of changes needed to sustain increases in NHS satisfaction and kick-start improvements in social care can be delivered in a consistent way that is noticeable to the British public. And, crucially for a government that has made the NHS a top priority, whether this can be done quickly enough for people to feel the benefit at the next election. 

Thea Stein is the Chief Executive of the Nuffield Trust and Sarah Woolnough is the Chief Executive of The King’s Fund.

A report by the Nuffield Trust and The King’s Fund on public satisfaction with the NHS and social care in 2025, revealing the results from the British Social Attitudes survey, has been published today.