NHS Underfunding Blamed for Public Dissatisfaction

Peter Russell

March 07, 2019

Years of austerity have led to the lowest levels of public satisfaction with the NHS in the UK for more than a decade, health service providers said.

The NHS Confederation warned of a tough challenge to restore confidence after the  2018 British Social Attitudes (BSA) survey, published by the Nuffield Trust and The King's Fund, found satisfaction continued a downward trend, despite the Government's announcement last June of an extra £20 billion spending for the NHS in England.

The survey identified particular dissatisfaction with the state of general practice, which led the Royal College of GPs (RCGP) to renew calls for urgent action to increase staffing.

Public Attitudes to the NHS and Social Care System

The survey, carried out by the National Centre for Social Research, found that:

  • Public satisfaction with the NHS stood at 53% in 2018 – a 3% drop from the previous year, and the lowest satisfaction level since 2007

  • Older people were more satisfied than younger people, with 61% of those aged 65 and over saying they were satisfied with the health service compared with 51% of people aged 18 to 64

  • Satisfaction with A&E services was 53%

  • Satisfaction with GP services was 63%, remaining at the lowest level since 1983

  • Satisfaction with NHS dentistry services was 58%

  • Satisfaction with social care services stood at 26%

Quality of care, the defining principle of the NHS as free at the point of delivery, the range of services, and the attitudes and behaviour of NHS staff were the main reasons why patients said they were satisfied with the NHS.

Top reasons for dissatisfaction were long waiting times, staff shortages, a lack of funding, and taxpayers' money being wasted, the survey found.

For 36 years, the BSA survey has asked a sample of the public how satisfied they were with the way the NHS is run. The latest survey, carried out between July and October 2018, was based on a nationally representative sample of 2,926 people.

Staff Shortages and Waiting Times

Ruth Robertson, senior fellow at The King's Fund commented: "Despite the outpouring of public affection around the NHS's 70th birthday and the Prime Minister’s 'gift' of a funding boost, public satisfaction with how the NHS is run now stands at its lowest level in over a decade.

"In the short term at least, the promise of more money doesn't appear to buy satisfaction. The public identified long-standing issues such as staff shortages and waiting times amongst the main reasons for their dissatisfaction and cash alone will not solve these."

Prof John Appleby, director of research, and chief economist at The Nuffield Trust, said: "Satisfaction with general practice – historically the service people were most satisfied with – has been falling for the past decade and is now at its lowest since the BSA survey began over 30 years ago.

"This may reflect continued strain on general practice, with mounting workloads and staff shortages and the evidence shows that people are finding it harder to get appointments than before. The NHS long-term plan expects even more of general practice – these problems will need to be addressed quickly if that vision is to be made possible."

The NHS Long-term Plan

Prof Helen Stokes-Lampard, chair of the RCGP, said: "Our workload has escalated, both in terms of volume and complexity in recent years but the share of the NHS budget general practice receives is less than it was a decade ago and the number of full-time equivalent GPs in England has actually fallen over the last 2 years.

"The NHS long-term plan has aspirations that will be good for patients - but we will need the workforce to deliver it. There is some great work ongoing to increase recruitment into general practice, and we now have more GPs in training than ever before – but when more family doctors are leaving the profession than entering it we are fighting a losing battle.

"The forthcoming NHS workforce strategy for England must contain measures to help retain GPs in the workforce for longer – steps to reduce workload to make working in general practice more sustainable and removing incentives to retire early for GPs who might not necessarily want to, would both be sensible places to start."

Niall Dickson, chief executive of the NHS Confederation, commented: "These findings show the inevitable consequence of starving the NHS of funding for the best part of a decade. We should be under no illusions about the scale of the task we face to restore public confidence in the health service.

"The public is right to be concerned about waiting times, staff shortages and inadequate funding levels – these are all major concerns for frontline health leaders.

"The gulf between satisfaction with NHS services and with social care is also highly concerning. This reflects the ongoing shortfalls in funding and workforce faced by social care, and the Government must take measures to address this."

The NHS Confederation said there were some grounds for optimism for the health service in England. It identified additional investment into primary care following the new GP contract, a 5-year funding settlement, and the long-term plan.

The Department of Health and Social Care pointed out that the survey covered all of the UK and not just England. A spokesperson said: "The NHS in England was recently ranked as the safest and best health service in the world, and its dedicated staff are delivering high-quality care to more patients than ever before.

"The launch of the long-term plan – backed [by] an extra £33.9 billion a year by 2023-24 – will safeguard our health service for generations to come and transform patient care by improving outcomes for major conditions, treating more people in their communities, and increasing the frontline workforce."


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