Public satisfaction with the NHS – what do the findings from the 2023 British Social Attitudes survey tell us?

The British Social Attitudes (BSA) survey assesses public mood about the NHS. It is the gold-standard measure of satisfaction among citizens who fund the health service through their taxes, patients who use its services, and voters who elect the political leaders charged with running it. So, in this, an election year, what do the results tell us?

The 2023 findings from NatCen’s British Social Attitudes Survey about the NHS are out. And it is perhaps unsurprising that public satisfaction continued to fall in a year of strikes, scandals and sustained long waits for care. 2023 saw little respite from the problems that have been driving public satisfaction down sharply since the Covid-19 pandemic.  

Yet while continued low levels of satisfaction were to be expected, both the scale of the fall and what sits behind it are alarming. Fewer than one in four – 24% of people – were satisfied with the NHS, with 52% dissatisfied. This represents a 29-percentage point drop in satisfaction in just three years – an unprecedented collapse.

The survey found low levels of satisfaction across all demographic and socio-economic groups and across all services. Satisfaction with every service – from A&E to dentistry – is at or near historic lows. These are shocking figures for a service that is seen as a crowning jewel in the British state, for which immense sacrifices were made during the Covid-19 pandemic, and which attracts such significant political and media interest. The situation in social care is even worse: satisfaction sits at a dismal 13%.  

So, what does this mean in an election year? The BSA allows us an unparalleled look back at how attitudes have changed over time, offering the longest consistent time series on public attitudes to the NHS available. And by looking at the last time that satisfaction was at historic lows – both before and after the New Labour government swept to power in 1997 – we can get deeper insights into the challenges that lie ahead. 

Here we see two trends that are worth highlighting: the patterns of satisfaction and dissatisfaction that we are now seeing are more consistent across the entire NHS than they were in the mid to late 1990s; and they are more consistent across the political divide.  

In the mid to late 1990s, despite relatively low levels of overall satisfaction with the NHS, satisfaction with GP services remained high over the same period. These high levels of satisfaction with GP services largely continued until the Covid-19 pandemic, when satisfaction with GP services plummeted. Other services experienced lower satisfaction than GP services in the mid to late 1990s, but nothing like the lows across the board we see now. Now overall satisfaction and satisfaction with all services are at record lows. This matters because the road back to higher levels of satisfaction will require a turnaround in all corners of the health service.

On party affiliation, we see similar issues: back in 1997 there was a 17-percentage point gap between Conservative and Labour voters’ answers about NHS satisfaction, with Conservative voters 11 percentage points more satisfied with the NHS than the survey average. In 2023, the gap between Conservative and Labour supporters was just 5 percentage points. We know that supporters of the party in power are more likely to be satisfied, so the deterioration in satisfaction among Conservative voters speaks to a wider malaise across the board than was present in 1997.

But this is not to say that a change in the party of government alone is enough to change the fortunes of a service experiencing low levels of satisfaction. While there was a bounce in satisfaction in the late 1990s, driven largely by increased satisfaction among Labour voters, it then fell steadily for two years and only started to climb when significant investment and reform was put into the NHS – eventually reaching 70% overall satisfaction in 2010.

On the topic of funding, the BSA also offers some unique insight. In 2023, we asked respondents about their views on taxation as a means for raising revenue for the NHS, offering them a choice between reducing taxes and spending less on the NHS; keeping taxes and spending on the NHS at the same level; or increasing taxes and spending more on the NHS. The results offer a fascinating counter to the political narrative around tax cuts, with just 6% of respondents opting to reduce taxes and spend less on the NHS. Almost half (48%) support increased taxation linked to higher NHS funding, with 62% of those in the highest monthly income quartile supporting this choice.  

On questions about the fundamentals of the NHS, the public are unequivocal in their support for the core principles that underpin the service – tax funded, free at the point of use, available to all. Support for these principles barely wavered in 2023, with more than 90% supporting its universality and more than 80% supporting it being tax funded and free at the point of use.  

As we approach a general election, the results of the British Social Attitudes survey could not be clearer: the public want shorter waits for care, better staffing levels and more funding. The public do not want a change in the model of health care; they want the existing model to work better for them, their families and their loved ones.