Patients’ overall experience of NHS and social care services

Background

To understand the quality of services that the NHS and social care deliver, it is important to know what people think about their care and treatment. The NHS Constitution includes a pledge to encourage and welcome feedback from patients on their experiences of health and care, and to use this to improve services. The national patient experience surveys ask service users how they rate the care they have received overall, the responses to which we explore below.

Several national patient surveys ask service users to rate their overall experience on a scale of 10 (very good) to 0 (very poor). It is useful to compare these responses to understand how experience varies across NHS services.

Patients with a primary diagnosis of cancer admitted to hospital as an inpatient or day case for cancer treatment were asked in the 2022 Cancer Patient Experience Survey how they felt about their overall experience. They responded most favourably of all the patient groups, with 88% rating their experience as 8, 9 or 10 and only 0.6% rating their experience as 0, 1 or 2. In contrast, only 46% of 2022 Community Mental Health Survey respondents rated their overall experience as 8, 9 or 10 and 12% rated their experience as 0, 1 or 2.

85% of 2020 Children and Young People’s Survey respondents (parents or carers of children aged 0–15 who had been admitted to hospital) rated their child’s experience as 8, 9 or 10 and 2% rated their experience as 0, 1 or 2. 69% of 2022 Adult Inpatient Survey respondents rated their overall experience as 8, 9 or 10, with 5% rating their experience as 0, 1 or 2. 56% of 2022 Urgent and Emergency Care Survey respondents who had attended type 1 departments rated their overall experience as 8, 9 or 10 and 10% rated their experience as 0, 1 or 2. 

The differences in responses between the surveys may reflect the demographics of respondents, as well as their experience of services. For example, older people tend to respond more positively in surveys, and a higher proportion of inpatients are of older age groups compared with community mental health service users. Further to this, although the most recent survey results are displayed here, they were undertaken at different times (fieldwork for the Children and Young People’s Survey was carried out before the pandemic, while the others were carried out during or after the pandemic).

The Urgent and Emergency Care Survey asks respondents to rate their overall experience on a scale of 10 (very good) to 0 (very poor). 67% of patients had a positive overall experience (scored 8, 9, or 10) in 2016, which increased very slightly to 68% in 2018. In 2020, experience of urgent and emergency care services was more favourable (72%) than any of the other years. In 2021, wait times for ambulances and A&E services grew tremendously, hitting record level lows in December 2022. It is perhaps unsurprising that in 2022, the percentage of respondents who reported a positive experience dropped to 56%. 

The GP Patient Survey asks respondents, ‘Overall, how would you describe your experience of your GP practice?’ The proportion of patients who had a good overall experience (‘very good’ or ‘fairly good’) of their GP practice decreased from 88% in 2012 to 85% in 2017. The proportion of patients who had a poor overall experience (‘very poor’ or ‘fairly poor’) increased from 3.6% in 2012 to 5.3% in 2017.

Changes to the 2018 GP Patient Survey resulted in this question not being directly comparable with previous years (see ‘About this data’ for more information). Between 2018 and 2021, the percentage of patients with a good overall experience remained consistently between 82% and 84%.

However, in 2022, the percentage of patients reporting a good overall experience dropped significantly to 72%. In 2023, it became 71%. The proportion of patients who had a poor overall experience more than doubled from 6% in 2018 to 14% in 2023. The worsening experience may be reflective of the mounting pressure that GP practices are currently facing and links to other data that show a decrease in accessibility of general practice services. 

The GP Patient Survey asks respondents, ‘Thinking about the reason for your last general practice appointment, were your needs met?’ In 2023, 57% of respondents said that their needs were definitely met, while 9% said that they were not met at all (data not shown).

Respondents are also asked what type of appointment their last general practice appointment was, such as a face-to-face or phone appointment. While the majority of respondents in 2023 said that their last appointment was a face-to-face appointment (70.4%; data not shown), since the start of the Covid-19 pandemic there has been an increase in phone and online appointments. Respondents who had a face-to-face appointment at the GP practice they were registered in were the most likely to say that their needs were met, with 62% saying that their needs were ‘definitely’ met. A lower percentage of respondents who had a face-to-face appointment at another GP practice (53%) reported the same outcome, suggesting that familiarity makes a positive contribution to meeting someone’s needs. 59% of respondents who had a home visit said that their needs were ‘definitely’ met. This compares with only 44% of respondents whose last appointment was an online appointment (which includes a video call, an online message or text) and 47% who had a phone appointment. Those who responded ‘Don’t know/Can’t say’ have been excluded for comparison purposes.

The GP Patient Survey asks people who have tried to get an NHS dental appointment in the last two years, ‘Overall, how would you describe your experience of NHS dental services?’ Between 2012 and 2016, the proportion of patients who had a good overall experience (‘very good’ or ‘fairly good’) increased from 83% to 85%, where it remained roughly constant until 2021 when it fell to 77%. Since then, it has dropped even lower, to 70% in 2023. The proportion of patients who had a poor overall experience (‘very poor’ or ‘fairly poor’) fluctuated around 7% between 2012 and 2020, before increasing to 11% in 2021 and rising further to 18% in 2023. The worsening of experience from 2021 onwards likely relates to the disruption of NHS dental services during the Covid-19 pandemic, and the inaccessibility of services that has persisted since the-pandemic, with only 1 in 10 practices accepting new adult inpatients. 

The Adult Inpatient Survey asks respondents how they rate their overall experience, on a scale of 0 (a very poor experience) to 10 (a very good experience). The proportion of respondents who rated their overall experience as 8, 9 or 10 increased from 67% in 2012 to 73% in 2017 but decreased slightly to 71% in 2019. The proportion who rated their experience as 0, 1 or 2 decreased slightly from 4% in 2012 to 3% in 2019.

In 2022, 69% of Adult Inpatient Survey respondents rated their overall experience as 8, 9 or 10, but 5% rated their experience as 0, 1 or 2. This was a marked decline from the results in 2020 where a higher proportion of respondents (75%) rated their overall experience as 8, 9 or 10. These results are not comparable with previous years due to changes in the 2020 survey (see ‘About this data’ for more information).

The Adult Social Care Survey asks respondents, ‘Overall, how satisfied or dissatisfied are you with the care and support services you receive?’ Between 2014-15 and 2019-20, the proportion of service users who reported that they were ‘extremely or very satisfied’ with the care and support services they received fluctuated between 64% and 65%. In 2020-21, 68% of service users reported that they were ‘extremely or very satisfied’ with the care and support services they received. Note that the 2020-21 survey was voluntary for councils to participate in, and so caution should be taken when looking at the council average, which is not an England outcome. In 2021-22, the proportion of those ‘extremely or very satisfied’ reverted to 64% and stayed that way in 2022-23. 

While levels of satisfaction have remained relatively consistent over the years, levels of dissatisfaction have changed. In 2014-15, 1.5% of respondents claimed to be ‘extremely or very dissatisfied’, a figure which increased to 2.4% in 2022-23. 

These results contrast with those from the Survey of Adult Carers in England, which asks how satisfied carers are with the support they and the person they care for have received from social services in the last 12 months. In 2021-22, only 36% of carers said that they were ‘extremely’ or ‘very’ satisfied, and this number has consistently declined since the first survey in 2012-13.

One interpretation of this data is that an increase in the volume of support provided is needed to improve the satisfaction of carers and the people they care for; however, for service users who do receive support the quality of care may have largely been maintained.