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Public Satisfaction with NHS and Social Care Falls to Record Low

NHS doctor David Oliver explains why the results of a damning new survey should alarm patients and healthcare professionals

Patients seen in a waiting room at a South London Hospital
A major survey on the public’s satisfaction with the NHS and social care has recorded some of the worst results ever. Patients are pictured above at a South London hospital waiting room. Photo: Janine Wiedel Photolibrary / Alamy Stock Photo

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A damning new survey reveals that less than a quarter of people are still satisfied with the NHS, with satisfaction levels around social care also hitting an all-time low.

Satisfaction levels around social care were the worst ever recorded, the Nuffield Trust noted, with just 13% of people questioned thinking they were acceptable.

The annual analysis by the King’s Fund and Nuffield Trust in the past year’s British Social Attitudes Survey (BSA) – carried out by the National Centre for Social Research (NatCen) in 2023 – and released March 27, makes grim reading for anyone who values the NHS and wants it to survive and thrive.

In the survey’s 41-year history, this was the first year that less than a quarter of people were “very or quite satisfied” with the NHS. This peaked in 2010, in the last year of the Tony Blair/Gordon Brown government when 7 out of 10 people were satisfied. The fall to 24% was from 29% in 2022, and 53% as recently as 2020.

A new survey on public satisfaction in the NHS and social care has revealed some of the worst statistics ever recorded. Photo: Nuffield Trust and the King’s Fund

The top reasons for respondents’ dissatisfaction were long waits for GP or hospital appointments, 71%, staff shortages, 54%, and a view that the Government does not spend enough on the health service, 47%.

Respondents’ top priorities for change 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, was next at, 47%, and in A&E, 45%.

Every year since 2015, a majority of respondents have said the Government does not spend enough on the health service, but this has hit a new peak of 84%.

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Almost half of respondents, 48%, would support the Government increasing taxes and spending more on the NHS, with that view most prevalent in people with the highest household income, while 42% felt taxation and spending should remain the same. Some six per cent wanted cuts.

Of those satisfied with the the level of service, the top reason was because the NHS care is free at the point of use, 66%, followed by it having a good range of services and treatments available, 53%, and the quality of care, 52%.

The BSA results come just weeks after the annual NHS Staff Survey which mirrored public attitudes.

The 2023 survey, which received a massive response rate of over 50%, showed that 30% of respondents felt burnt out by their work, and 34% found it emotionally exhausting. Just over half, 57%, said their organisation took positive action on health and wellbeing.

Less than half felt able to meet the conflicting demands of their work, and only a third felt their workplace had enough staff for them to do their job properly. A quarter said that they never faced unrealistic time pressures.

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These are just the conditions to create “moral distress” where staff are coming to work every day, unable to deliver the professional standard of care they want to, knowing they are letting patients down but constrained by a system lacking resources, capacity and staff.

A quarter of NHS workers said that they’d been subject to harassment, abuse, or bullying from members of the public, and another 28% had experienced it from managers or colleagues. Only half of those workers said that they’d reported such incidents.

Only 54% of those surveyed believed their organisation acted without discrimination and with fairness regarding career progression, yet we still have ridiculous weaponisation by the right of culture wards about equality, diversity and inclusion policies, training and a handful of designated staff to manage this clearly needed work.

It is especially concerning after a whole series of public care failings, scandals and inquiries and both a professional duty of candour and transparency (for clinical staff) and a statutory duty of candour for organisational leaders) that only 62% of respondents felt safe speaking up about concerns affecting patient safety in their organisation, and 50% believed that those concerns would be listened to or acted on by managers.

Most concerning of all was the finding that only 61% of respondents would recommend their organisation as a place to work, and only 64% would recommend it as a place for their friends or family to receive care.

Is it any surprise that the NHS has such a retention problem, with so many clinical staff leaving or signalling an intent to leave?

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Social Care’s crisis is even more pressing. The annual Skills for Care report on the State of the Social Care Sector and Workforce for 2023 showed that 1 in 10 posts were unfilled and serious problems with retention, due to poor terms, conditions and support, compounded by the impact of immigration rules, pay and competing sectors on recruitment. This, along with the growing crisis in social care and local government funding is making provision unviable.

No wonder public satisfaction with social care is so low, further compounded by it being heavily rationed and means tested, with the Government repeatedly ducking sustainable solutions and a growing gap opening between requests for assessment, care and support and their provision.

What strikes me about these two surveys it that the staff experience – also at an all time low over the past two years’ surveys – and public satisfaction are so closely aligned. The staff know they are working in a broken system, close to a cliff edge, close to a critical transition point from which there may be no return. The public see it. And it is no fun working in a service that the patients and families are so unhappy with.

Among all this gloom, there are some points of hope and unity. The overwhelming majority of BSA respondents expressed high levels of support for the founding principles of the NHS, when asked if they should still apply in 2023: that it should be free of charge when you need it, 91%, primarily funded through taxation, 82%, and available to everyone 82%. There is no clamour for a sea change in funding mechanism or a shift to market-based provision and competition.

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As for the staff survey, commitment to the NHS values and spirit remained strong. Nearly 9 in 10 staff thought that their role made a difference to patients, and 7 in 10 said that the care of patients was their organisation’s top priority.

This year’s survey shows little difference between what Conservative and Labour voters want to see change – so you’d think the politicians would be pushing at an open-door and act on voters’ priorities and the commitment of the staff who are still keeping on keeping on even after the traumas of COVID.


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