The latest British Social Attitudes (BSA) survey reveals that public satisfaction with the NHS fell by 17 percentage points between 2020 and 2021. Overall satisfaction with the NHS is now at 36%, down 17 percentage points from 2020, the lowest level recorded since 1997 and the largest year-on-year drop in the history of the BSA survey.
This dramatic fall in satisfaction is mirrored across all NHS services – from inpatients and outpatients to accident and emergency, as well as general practice and dentistry – and across nearly all demographic groups.
The survey, carried out in early autumn 2021, coincided with an extraordinary time. Covid-19 had had a terrible impact on people’s lives and the economy, and had severely tested the resilience of the NHS. The need to prioritise the treatment of patients with Covid-19, to set up services that limited the risk of infection and to then deliver the largest vaccine programme in the country’s history meant that the NHS had had to deprioritise care and treatment in other areas. And all this when the service was already under considerable strain: there were large numbers of staff vacancies and millions of people on waiting lists for treatment before the pandemic took hold. The public were asked to play their part in this collective endeavour and ‘Protect the NHS’. And they did.
As the pandemic began, people largely accepted the need to change to different ways of accessing care and for the most part accepted delays in referrals and treatment. We know from the GP Patient Survey, conducted in early 2021, that large numbers of people avoided making GP appointments in the first year of the pandemic so they would not be a burden on the NHS. ‘Clap for carers’ showed the huge amount of goodwill there was towards the NHS and its staff in the early stages of the pandemic.
Polling by YouGov suggests a ‘halo effect’ around the NHS in the first year of the pandemic and that high levels of satisfaction were as much a measure of support for the NHS and its staff as a reflection on the services provided. However, as the pandemic wore on, this appears to change. Public attitudes research by BritainThinks in May and June 2021 concluded that ‘for the first time in this programme of work, there are indications that the Covid-19 “grace period” is coming to an end.’
By the time respondents were completing the 2021 BSA survey in mid-September 2021, key aspects of NHS performance were continuing to deteriorate. There were nearly 6 million people on waiting lists in England up from 4.4 million before the pandemic hit. There was a debate raging in the media around access to general practice and particularly about face-to-face appointments. It is important to remember that, behind the numbers and headlines, there are people who are living with pain and anxiety because they are unable to get the care they need and families who are worrying as their loved ones wait for treatment.
The public recognise the challenges Covid-19 has placed on the NHS and particularly its staff but the public’s increasing frustration with their own experiences of accessing health care is clearly evident when asked, as part of the BSA survey, what the NHS should prioritise. The answers were: make it easier to get a GP appointment (48%), improve waiting times for planned operations (47%) and increase the number of staff in the NHS (47%). It is hard to see how the NHS can deliver the first two priorities if it does not have the staff to do so – something the public have recognised for some time now. And it’s hard to improve staffing without adequate funding. Again, the public recognises this, with eight in 10 agreeing the NHS has a ‘major’ or ‘severe’ funding problem.
Addressing these priorities will no doubt lead to an improvement in overall satisfaction with the NHS but it will take time as the NHS and its workforce recover from the pandemic and everything it is has brought. Pretending the NHS will get back on an even keel any time soon is unrealistic and will only serve to increase expectations that cannot be met. Expectations that are likely to be raised further when taxpayers start paying the new Health and Social Care Levy on 6 April 2022.
So far, the government and the NHS have recognised this and have been open in emphasising that hospital waiting times are likely to get worse before they get better. But as the BSA survey has shown, dissatisfaction stretches across all NHS services – not just hospital care – and includes general practice and dentistry. Fixing hospital waiting lists is only part of the problem. The government and the NHS need to communicate clearly with the public about the steps they are taking to improve services, what people can expect and when, and resist the temptation to descend into a blame game as public concern and political pressures increase.
Although these survey results seem very gloomy for the NHS, the public’s faith in the core principles of the service does not appear to have been eroded. The overwhelming majority of respondents in 2021 agreed that the founding principles of the NHS ‘definitely’ or ‘probably’ apply: that the NHS should be free of charge when needed (94%), that the NHS should primarily be funded through taxes (86%) and that care should be available to everyone (84%).
It would seem that the public do not want a radical overhaul of the NHS, rather a health service that is appropriately funded and staffed to deliver the quality of care they need.