Restoring public confidence in the NHS will be no easy feat

With the latest British Social Attitudes survey showing that public satisfaction with the NHS has fallen to the lowest level ever recorded, Professor Sir John Curtice looks back at satisfaction with the health service over the years and points out that the lesson for policy-makers is much the same as two decades ago.

Blog post

Published: 21/04/2023

One of the key achievements of the New Labour government of 1997-2010 was to reduce waiting lists and waiting times for NHS treatment. Moreover, voters noticed. In 2009, the British Social Attitudes (BSA) survey was reporting that 37% reckoned the time people had to wait for an outpatient appointment – a reduction in which was a key target for the government – had got better over the last five years. In 1995, the figure had been just 17%. At the same time, 36% thought the time people had to wait for hospital treatment had got better, whereas only 21% felt that it had got worse.

Levels of satisfaction with the NHS improved dramatically. When Labour came to power in 1997, as many as half (50%) said they were dissatisfied with the NHS overall, while only around a third (34%) were satisfied. By the time Labour left office in 2010, only 18% expressed dissatisfaction, while as many as 70% said they were satisfied – more than had done so at any point since BSA first asked the question in 1983. It looked as though the reduction in waiting for treatment had helped turn perceptions of the health service around; certainly, detailed analysis of the data indicated that the perception that waiting times for hospital treatment had improved was particularly strongly linked to satisfaction with NHS.

Now, however, the picture is once again much as it was in the late 1990s – indeed satisfaction with the NHS overall is even lower than it was then. In the latest BSA, whose findings on the health service were released last month, just over half (51%) say they are dissatisfied with the service, similar to the 50% who did so in 1997. Only 29% say they are satisfied – even fewer than in 1997 and a record low in the BSA time series.

Meanwhile, perceptions of parts of the NHS are markedly more negative now than they were a quarter of a century ago. In particular, as many as 42% are dissatisfied now with GP services. Hitherto GPs have been the most highly rated part of the NHS, one in which in 1997 only 13% expressed dissatisfaction. Now, however, the GP service trails both inpatient and outpatient services quite considerably.

Changing numbers

Much of this dissatisfaction has arisen in the wake of the Covid-19 pandemic. In 2019, satisfaction with the health service overall still stood as high as 60%, while only 25% were dissatisfied. Two years later, when most of the public health measures that had been taken to limit the spread of Covid-19 were being withdrawn, only 36% were satisfied, while 41% were dissatisfied – the first time for nearly 20 years that those dissatisfied had outnumbered those who were satisfied. The most recent survey suggests that since then we have simply witnessed a further deterioration in the level of satisfaction.

The pandemic has, of course, had a profound impact on the NHS. Much routine care was put on hold as hospitals endeavoured to deal with an influx of Covid-19 patients suffering from the disease. The longer-term consequence has been much increased waiting lists and waiting times – for example, the waiting list for hospital treatment in England has increased from 4 million to over 7 million. And just as waiting for treatment was a key concern for the public at the beginning of this century, so it also is now.

Presented with a set of possible reasons as to why they might be dissatisfied with the NHS overall, no less than 69% of those expressing dissatisfaction in the latest BSA picked out that “it takes too long to get a GP or hospital appointment”. It was by far the most popular explanation. Meanwhile, the next most common reason endorsed by those dissatisfied with the service, in this instance by 55%, was that there were “not enough NHS staff” – again an indication of public concern about the capacity of the NHS. Indeed, as many as 36% mentioned both waiting times and staff shortages.

As we might anticipate, even in better times, those who expressed dissatisfaction with the health service often mentioned waiting times. In 2019, before the pandemic, 57% of those who at that stage were dissatisfied picked out the issue as at least one of the reasons for their dissatisfaction. Even so, as dissatisfaction has increased so also has the proportion who are expressing concern about waiting times.

Can public expectations be met?

The lesson for policy-makers from the latest BSA results is much the same lesson as 20 years ago. The public – over nine in 10 of whom still back the idea that the NHS should be “free of charge when you need to use it” – expect their health service to deliver the treatment they need within a reasonable time frame. New Labour were able to meet that expectation with the help of targets and a significant increase in health spending. The key question now is whether that expectation can be met once more at a time when finance is tight and staffing constrained. Restoring public confidence in the NHS is unlikely to prove easy.

Professor Sir John Curtice is a Senior Research Fellow at the National Centre for Social Research. He has written and spoken extensively about voting behaviour in elections and referendums in the UK, as well as on British political and social attitudes.

Suggested citation

Curtice J (2023) “Restoring public confidence in the NHS will be no easy feat”, Nuffield Trust guest blog