Politics and satisfaction with the NHS

Alongside our new report on the British Social Attitudes survey, John Appleby looks at the links between people’s political allegiances and how satisfied they are with the NHS.

Blog post

Published: 28/02/2018

Whatever one’s views on the matter, there’s no escaping the fact that the NHS and politics are bound up together. And that’s no surprise given the history of its birth, the way we pay for the health service and the inevitable role of politicians and the party in power in shaping policy towards the NHS – and of course – how much funding it receives.

But what about the converse? How do the party allegiances of the public affect views and attitudes towards the NHS? Does the political party with which you identify influence your satisfaction with the NHS? And is there any connection between party allegiance, satisfaction with the health service and the colour of the political administration? Or do people’s views about the NHS transcend both personal politics and the party in power?

We’ve got answers

The latest results from the long-running British Social Attitudes (BSA) survey (carried out by the National Centre for Social Research, with some questions about the NHS sponsored by the Nuffield Trust and the King’s Fund) provide some of the answers.

Conducted in late summer and early autumn of last year, the BSA survey once again asked the question: “All in all, how satisfied or dissatisfied would you say you are with the way in which the National Health Service runs nowadays?”

It also asks respondents which (if any) political party they most identify with (not voting intention). The weighted sample for the 2017 survey was 3,014 – and the party identification breakdown is illustrated in this chart.

Party identification breakdown for the 2017 British Social Attitudes survey 28/02/2018

Chart

Source:  

King’s Fund and Nuffield Trust analysis of NatCen Social Research’s British Social Attitudes survey data.

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Since the peak in 2010 when 70% stated that they were very or quite satisfied with the NHS, this has now fallen to 57% across the whole survey sample.

And, as the chart below shows, in 2017 this was mirrored across all parties. There was a 2 percentage point fall between 2016 and 2017 among those identifying with the Liberal Democrats, a 4 percentage point fall for Conservatives and an 8 percentage point fall for Labour supporters. Only the change for Labour supporters was statistically significant, however.

This takes satisfaction for Labour supporters back to levels in 2006, and for Conservative supporters to 2009.

Public satisfaction with the NHS and party identification: 1983 to 2017 28/02/2018

Chart

Note:  

Question asked: “All in all, how satisfied or dissatisfied would you say you are with the way in which the National Health Service runs nowadays?” (This chart shows the respondents who answered ‘very’ and ‘quite’ satisfied.)

This question was not asked in 1985, 1988 and 1992.

Source:  

King’s Fund and Nuffield Trust analysis of NatCen Social Research’s British Social Attitudes survey data.

Read more

Taking a closer look

Looking back over the whole of the BSA survey period (back to 1983), and superimposing the periods of party rule over that time, it is not necessarily obvious there is a relationship between the party in power, satisfaction with the NHS and respondents’ party identification.

For the period of Labour administrations from 1997 to 2010, for example, satisfaction with the NHS generally increased regardless of people’s own politics. This was also a period when the government allocated significantly more money to the NHS and, what’s more, had something tangible to show for it, not least in vastly reduced waiting times – something it seems that was noticed and appreciated across the political spectrum.

So maybe, when it comes to the NHS, the public are not as politically partisan as might be suspected.

But look a bit closer and you can detect some connection between ‘Politics’ and politics.

When Labour came to power in 1997, satisfaction with the NHS among Labour supporters rocketed from a paltry 28% to 50% in just two years. It is hard to imagine what wonders the NHS managed to perform in two years to justify such a huge increase.

But this initial surge took a knock in 2000 and 2001 when satisfaction fell. The honeymoon period was over and the balance of influences driving people’s attitudes towards the NHS had perhaps swung to more practical issues such as the Labour supporter’s (and others’) views about the performance of the NHS (particularly waiting times).

The fall in satisfaction in 2011 among both Liberal Democrat and Conservative supporters, despite the coalition of these parties in power at the time, is also perhaps an example of partisanship taking a back seat (at least for a while). The large drop in satisfaction across all political supporters in that year almost certainly reflected unease through to acute worry about the NHS, arising from controversial reform proposals from the then Secretary of State Andrew Lansley. 

But on the other hand, also look at the period of Conservative government administrations from 1983 (when the survey started) to 1997. Satisfaction across all party supporters bobs up and down, but it is Conservative supporters who consistently express higher satisfaction with the NHS than supporters of Labour or the Liberal Democrats.

And to back up this observation with some numbers, the chart below shows the difference between Labour and Conservative supporters’ satisfaction with the NHS over time. There is a reasonably clear pattern of Labour supporters being less satisfied than Conservative supporters during periods of Conservative rule and more satisfied during periods of Labour rule (and vice-versa of course).

Public satisfaction with the NHS: party in power and party identification of BSA respondents (1983 to 2017) 28/02/2018

Chart

Note:  

Respondents expressing they are “very” or “quite” satisfied with the overall running of the NHS: those identifying as Labour supporters minus those identifying with the Conservative party.

Source:  

King’s Fund and Nuffield Trust analysis of NatCen Social Research’s British Social Attitudes survey data.

Read more

What’s behind the satisfaction levels?

There are of course lots of reasons for being satisfied or dissatisfied with the NHS, so the BSA survey also asked respondents what lay behind their views.

As the two charts below suggest, there’s a tendency (and to adapt from Anna Karenina) for all satisfied political groups to be alike, but each dissatisfied group to be dissatisfied in its own way. Whereas, for example, 70% of dissatisfied Labour supporters cite lack of staff as a reason for their dissatisfaction, only 40% of Conservative supporters do so.

An exception perhaps is the relative unity among both Labour and Conservative supporters that waiting times are one underlying reason for their dissatisfaction.

Reasons to be satisfied with the NHS 28/02/2018

Chart

Note:  

Question asked: “You said you are satisfied with the way in which the National Health Service runs nowadays. Why do you say that? You can choose up to three answers.” (Options presented on a card.)

This question was asked of a random third of those who said they were “quite” or “very” satisfied with the way the NHS runs nowadays, (n=541 – of which, those identifying as Conservative = 177, and Labour = 212). NB: Liberal Democrats and other parties excluded due to low numbers.

Source:  

King’s Fund and Nuffield Trust analysis of NatCen Social Research’s British Social Attitudes survey data.

Read more

Reasons to be dissatisfied with the NHS 28/02/2018

Chart

Note:  

Question asked: “You said you are dissatisfied with the way in which the National Health Service runs nowadays. Why do you say that? You can choose up to three answers.” (Options presented on a card.)

This question was asked of a random third of those who said they were “quite” or “very” dissatisfied with the way the NHS runs nowadays, (n=324, of which, those identifying as Conservative = 91 and Labour = 133). NB: Liberal Democrats and other parties excluded due to low numbers.

Source:  

King’s Fund and Nuffield Trust analysis of NatCen Social Research’s British Social Attitudes survey data.

Read more

So, if you’re a political party and want to boost satisfaction with the NHS among your supporters, get into power. But if you want to raise satisfaction across the board, more than simply being in government, you will need to ensure the NHS delivers tangible benefits for the public – not least reductions in waiting times.

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