Public satisfaction with the NHS slumps to new record low

Public satisfaction with the NHS has fallen to the lowest level ever recorded, according to analysis of the latest British Social Attitudes survey (BSA) published today by The King’s Fund and the Nuffield Trust.

For the first time in the 41-year history of the survey,¹ less than a quarter of people are satisfied with the way the NHS is running. Satisfaction had previously peaked in 2010, when 7 out of 10 people reported being satisfied with the health service.

Overall public satisfaction² with how the NHS runs now stands at 24% – a fall of 5 percentage points from the previous year. Since 2020, satisfaction has fallen by 29 percentage points. Dissatisfaction is also at an all-time high, with more than half (52%) of respondents saying they were dissatisfied with the NHS.

The survey,³ carried out by the National Centre for Social Research (NatCen) in September and October 2023, is seen as a gold-standard measure of public attitudes in Britain.

Nearly three quarters (71%) of respondents who were dissatisfied with the NHS pointed to long waiting times for GP and hospital appointments as one of their top reasons for dissatisfaction, followed by staffing shortages (54%), and a view that the government does not spend enough on the health service (47%).

Since the 2015 survey, a large majority of respondents have consistently expressed the view that the NHS has a major or severe funding problem, with 84% of respondents to the 2023 survey now sharing this view.

In a new question introduced for the 2023 survey,⁴ nearly half (48%) of the public would support the government increasing taxes and spending more on the NHS. Those on the highest household incomes were more likely to choose this option.

Despite record low levels of satisfaction with the NHS, public support for the founding principles of the NHS, which marked its 75th anniversary in 2023, is as strong as ever. The overwhelming majority of respondents expressed high levels of support for the principles when asked if they should still apply in 2023: that it is free of charge when you need it (91%), primarily funded through taxation (82%) and available to everyone (82%).

Other findings from Public satisfaction with the NHS and social care in 2023 include:

• Of those who were satisfied with the NHS, the top reason was because NHS care is free at the point of use (66%), followed by the NHS has a good range of services and treatments available (53%) and the quality of NHS care (52%).
• Consistent with previous years’ surveys, when asked what the most important priorities for the NHS should be, the top two cited by respondents were making it easier to get a GP appointment (52%) and increasing the number of staff in the NHS (51%). Improving waiting times for planned operations and in A&E were chosen by 47% and 45% of respondents respectively.
• When asked about government choices on tax and spending on the NHS, 48% chose ‘increase taxes and spend more on the NHS’, 42% chose ‘keep taxes and spending the same’, and 6% chose ‘reduce taxes and spend less on the NHS’. Those in the highest monthly household income quartile were more likely to choose ‘increase taxes and spend more on the NHS’.

As we approach an election in 2024, low levels of satisfaction are now more consistent across the political divide than in previous years when public satisfaction had dropped. In in the years leading up to the general election in 1997, when satisfaction dropped to 34%, Conservative supporters were consistently significantly more satisfied than Labour supporters. In 2023, Conservative supporters reported only marginally higher levels of satisfaction than Labour supporters (29% and 24% respectively) and levels of dissatisfaction were similar across supporters of both parties.

The survey also measures public opinion on specific NHS services. The think tanks’ analysis reveals that public satisfaction with GP services – historically the service with the highest levels of public satisfaction – now stands at 34%, the lowest level recorded since the survey began. Since 2019, satisfaction with GP services has fallen by 34 percentage points. Satisfaction with NHS dentistry has now fallen to a record low of 24%. Public satisfaction with inpatient services is at a historically low level (35%) as is satisfaction with outpatient services (44%). 31% said they were satisfied with A&E services, up 1 percentage point on the previous year.

The survey reveals that public satisfaction with social care has fallen to 13%, the lowest level since the survey began. Satisfaction with social care is significantly lower than satisfaction with the NHS overall or any of the individual NHS services asked about.

The top reason for dissatisfaction with social care was inadequate pay, working conditions and training for social care workers (57%), closely followed by people not getting all the social care they needed (56%) and there not being enough support for unpaid carers (49%).

Dan Wellings, Senior Fellow at The King’s Fund said:

"These results are depressing but sadly not surprising. The NHS has seen no respite from the issues that have led to an unprecedented downward spiral in public satisfaction in recent years. 

"With the health service increasingly unable to meet the expectations and needs of those who rely on it, public satisfaction with the NHS is now in uncharted territory. The size of the challenge to recover it is growing more difficult with each passing year. Ahead of the upcoming general election, political leaders should take note of just how far satisfaction with this celebrated public institution has fallen.

"The public are clear that they want shorter waits for care, better staffing levels and more funding. Despite the challenging economic circumstances, our analysis suggests that one in two people may be prepared to pay more for the NHS through taxation, especially those with the deepest pockets."

Jessica Morris, Fellow at The Nuffield Trust said:

"The next government will inherit an NHS with a record low level of satisfaction with the way in which it’s running. It is worrying how consistent this is across different NHS services, with inpatient, outpatient, dentistry and GP services reporting record low levels of satisfaction. As we approach a general election, political parties should be frank and realistic about the challenges ahead of them if they are to turn this situation around.   

"Despite such low levels of satisfaction, the public continue to back the principles underpinning the NHS. The public has not fallen out of love with the idea of a publicly funded, free at the point of use NHS, but they are losing confidence that it will support them and their loved ones in the best possible way when they need it."

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For further comment or to arrange an interview, please contact:

Gemma Umali g.umali@kingsfund.org.uk or Sophie Anderton s.anderton@kingsfund.org.uk, 020 7307 2585