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1 March 2018updated 09 Sep 2021 5:23pm

Growing public discontent shows it is make or break time for the NHS

We are now at a point where the NHS can no longer meet the standards of care set out in its constitution with the resources available.

By Daniel Reynolds

Levels of public satisfaction have become a powerful measure for understanding how the NHS is performing. Amid all the concerns in recent years over growing delays for treatment, rationing of care, understaffing and so on, the public view of the NHS has defied gravity and remained stoically positive. That is, until now.

The latest findings from the influential British Social Attitudes (BSA) survey – now in its 36th year – reveal that despite the efforts of NHS staff, public dissatisfaction with the service is at a 10-year high. Given the value placed on the survey by governments of all political persuasions over the last four decades, the findings could and should have far reaching implications for decisions taken by the government ahead of next year’s spending review.

Collected by the National Centre for Social Research and analysed by independent think tanks the Nuffield Trust and King’s Fund, the survey reveals public satisfaction with the NHS is still relatively high – at 57 per cent – but that it has fallen by 6 percentage points in the last year. Dissatisfaction with the NHS is now at 29 per cent – nearly double the level recorded in 2014.

That we find ourselves in this position will be of no surprise to many, given the NHS is now eight years into the longest financial squeeze in its history. But perhaps what is surprising is that it has taken this long for public awareness to catch up with the scale of the challenge. That in itself is credit to NHS staff for maintaining high standards of care in spite of constrained funding and staff shortages. And it is worth noting there are many elements of the NHS that the public are still very positive about, most notably: the quality of care and range of treatments available, the attitudes and behaviour of staff, and the fact the service remains free at the point of use.

These findings are important as this is not just any old poll. While some polling has lost its allure since the miscalculations over the general election and EU referendum outcomes, the BSA survey is the most robust undertaken into public opinion on the NHS. It provides a rare and insightful guide into long-term trends, charting public opinion since 1983 and covering the premierships of prime ministers from Margaret Thatcher to Theresa May. Over those four decades satisfaction has waxed and waned in response to the question: “How satisfied or dissatisfied would you say you are with the way in which the NHS runs nowadays?”

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While there isn’t an obvious relationship between the party in power and public satisfaction with the NHS – as this blog from John Appleby shows – satisfaction dipped in the 1990s and increased from 1997 onwards. This period coincided with an increase in NHS spending and reduced waiting times. Despite an initial dip in satisfaction at the start of the coalition years, satisfaction levels were encouraging for the rest of the 2010-15 parliament.

However, in recent years, the NHS has been unable to recover the high watermark levels of 2010, when 70 per cent of the public said they were very or quite satisfied with the NHS. Satisfaction levels are declining at a time when pollsters such as IpsosMori are reporting an increase in the proportion of the public who are worried about the NHS.

The reasons behind the drop in satisfaction make for interesting reading. The findings suggest public dissatisfaction is being driven by concerns over funding and staffing levels, as well as lengthening waiting times and the impact of government reforms.

What is especially interesting is how public attitudes to the things NHS trusts and other parts of the service can control has changed compared to attitudes to the government and what it is ultimately responsible for. Between 2015 and 2017, there has been a jump in the proportion of respondents who think the government is not spending enough on the NHS – from 39 per cent to 51 per cent – while there has been a drop in the proportion of people who think the NHS is “wasting money” – from 35 per cent to 25 per cent. Public recognition of the need for extra resources in the NHS is rising.

The research adds further weight to the view – expressed by NHS Providers and others – that the NHS is at a watershed moment. Despite the BSA survey once again finding unwavering support for the principles of the NHS, the public is worried about the service. We are now at a point where the NHS can no longer meet the standards of care set out in its constitution with the resources available.

It is particularly disappointing to see satisfaction slipping across all age groups just as the NHS nears its 70th anniversary, which should be a moment of national pride and optimism for a cherished institution.

But this shift in public mood has been a long time coming and the warning must serve as a wake-up call to political leaders of all persuasions. The public are watching and they clear the NHS must get the extra funding and staff it needs to survive and thrive for another 70 years.

Daniel Reynolds is director of communications at NHS Providers, which is the membership organisation for acute hospitals, community, mental health and ambulance trusts. 

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