Can’t get no satisfaction: why are we less impressed with the NHS?

Helen Howson responds to findings from the King’s Fund and Nuffield Trust report on ‘Public satisfaction with the NHS and social care in 2018’. In this article she explores the reasons behind why we are less satisfied with the NHS and what can be done to turn public opinion around.

2018 was a year of public celebration for what is often called our most beloved institution: the National Health Service. Scarcely a day went by without a conference, party, film, launch or lunch to mark 70 years of the NHS.

But, as a report produced by the King’s Fund and Nuffield Trust indicated, this outpouring of nostalgia and celebration did not result in an upswing in public satisfaction. In fact, this measure hit an 11-year low across the UK in a year which was intended to act as a much-needed confidence boost for our stretched NHS. So what’s going wrong?

Lowest since 2007

A report from think tanks The King’s Fund and Nuffield Trust (based on NatCen Social Research’s British Social Attitudes survey) found that overall satisfaction with the NHS was 53%. This represented a 3% drop from 2017 and the lowest level of satisfaction in 11 years.

The report found that reasons for dissatisfaction include long waiting times, not enough staff, a perceived lack of government funding and wasted resource. At a time when the NHS is the focus of febrile political debate and Brexit uncertainties, it is perhaps unsurprising that the reasons behind public dissatisfaction reflect many recent headlines and soundbites.

The pattern of public satisfaction with the NHS from 1983 (when the British Social Attitudes survey began) to 2018 also seemingly reflects economic, social and political fluctuation.

Meanwhile, in terms of public satisfaction with the NHS, the reasons to be cheerful include: quality of care; the fact that the NHS is free at the point of use; the services and treatments available; and the behaviour of NHS staff.

Listening is vital

It is perhaps inevitable that the NHS could act as a lightning rod for public opinion depending on the economic, political and social climate. However, to dismiss public dissatisfaction with the NHS as mere collateral damage in a time of turmoil would be to ignore valid feedback which can help us to improve the service.

A report from the Bevan Commission, 1000 Lives Improvement, Swansea University Medical School and Gwent Association of Voluntary Organisations (GAVO) on ‘Patient driven solutions’ found that feedback generated through the Education for Patients Programme (EPP Cymru) was routinely discarded.

By salvaging and analysing this feedback, we found that patients were often unaware of specialist services and wanted to be able to prepare themselves before attending appointments by reviewing their own medical notes and accessing other health-related information. Solutions they suggested included developing health literacy for all, giving patients access to their own health records and improving communication with frontline staff by reducing jargon and managing patient expectations.

Similarly, a recent report from the Community Health Council on ‘Communication in the NHS in Wales’ found that people did not always feel in control of their own health and care and sometimes struggled to find the information they needed to access NHS services.

If the NHS was a business, the views of its customers would be paramount for designing its services – we ignore them at our peril!

Empowering people

While we can all support calls for more resource for the NHS to address public dissatisfaction, this is not a panacea and there are other factors that are more directly in our control and cost little. Ensuring that people feel empowered, informed and supported to take control of their health and care could pay dividends in both health outcomes and patient  satisfaction.

Small steps, from communicating issues clearly to enabling patients to take greater control of their health (i.e. monitoring devices, medicines management), can make a huge difference in ensuring that everyone feels a sense of responsibility for their own good health and care as well as for their family and friends.

We all know that the NHS is stretched, and that it is facing major challenges in terms of an ageing population and workforce recruitment. What is less well-understood is the role that we can all play in contributing to its future. The Tredegar model which famously inspired the National Health Service was built on the core principle of communal responsibility.

So perhaps the question should not be whether we are satisfied with the NHS, but whether we are satisfied with our own contribution towards making it successful. What would be your response?

Helen Howson is Director of the Bevan Commission, Wales’ leading think tank for health and care, hosted and supported by Swansea University School of Management.

The views contained within this blog are those of the author and do not necessarily represent the views of the Bevan Commission.

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