public satisfaction with the nhs and social care in 2018 · introduction 2 public satisfaction with...

Public satisfaction with the NHS and social care in 2018Results from the British Social Attitudes survey

Ruth Robertson

John Appleby

Harry Evans

Nina Hemmings

March 2019

Public satisfaction with the NHS and social care in 2018

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ContentsIntroduction 2

Keyfindings 3

How satisfied is the British public with the NHS overall? 5

Who is most satisfied with the NHS? 8

Why is the public satisfied or dissatisfied with the NHS? 11

How satisfied is the British public with different NHS and social care services? 17

Conclusion 26

Appendix:Methodology 27

References 28

Acknowledgements 30

Abouttheauthors 31

Contents 1

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Introduction 2


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IntroductionSince1983,NatCenSocialResearch’sBritishSocialAttitudes(BSA)surveyhasaskedmembersofthepublic–ratherthanonlypatients–inEngland,ScotlandandWalesabouttheirviewsontheNHSandhealthandcareissuesgenerally.ThelatestsurveywascarriedoutbetweenJulyandOctober2018andaskedanationallyrepresentativesampleof2,926peopleabouttheirsatisfactionwiththeNHSoverall,and973peopleabouttheirsatisfactionwithindividualNHSandsocialcareservices.The2018BSAsurveyquestionsreportedherewerejointlysponsoredbytheNuffieldTrustandTheKing’sFund.

TheBSAisa‘goldstandard’surveythatusesarobustmethodologytoexplorepublicviews.ThemethodologyisbasedonarandomlyselectedsampleoftheBritishpublic,andisconductedviaaface-to-faceinterview,withmultiplefollow-uprequeststonon-responders.Thesurveyisconductedthesamewayeveryyearandthedataprovidesarichtimetrendgoingbackto1983,addingadepthandcontexttothefindingsthatnoothermeasureofNHSsatisfactionprovides.Asaresult,whensatisfactionchangesintheBSA,weareasconfidentaswecanbethatitreflectsagenuinechangeinpublicattitudes.

Intheanalysisbelow,whenwesaysatisfactionhasgoneupordown,thechangeisstatisticallysignificantatthe5percentlevel,unlessotherwisestated.Ifachangeordifferenceisstatisticallysignificant,thismeanswecanbe95percentconfidentthatthesurveyresultreflectsarealchangeordifferenceinpublicviews,ratherthanbeingdowntochance.Whereachangeordifferenceisnotstatisticallysignificant,wecannotbeconfidentthatitreflectsarealchangeordifferenceinpublicviews.

Keyfindings 3


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Key findings Satisfaction with the NHS overall in 2018

• PublicsatisfactionwiththeNHSoverallcontinuedtofallin2018.Overallsatisfactionwas53percent–a3percentagepointdropfromthepreviousyearandthelowestlevelsince2007.

• Olderpeopleweremoresatisfiedthanyoungerpeople:61percentofthoseaged65andoverweresatisfiedwiththeNHScomparedto51percentofthoseaged18–64.

• Satisfactionlevelsalsodifferedbetweensupportersofdifferentpoliticalparties:58percentofsupportersoftheConservativepartyweresatisfiedcomparedto51percentofsupportersoftheLabourparty.

• ThefourmainreasonspeoplegaveforbeingsatisfiedwiththeNHSoverallwere:thequalityofcare;thefactthattheNHSisfreeatthepointofuse;therangeofservicesandtreatmentsavailable;andtheattitudesandbehaviourofNHSstaff.

• ThefourmainreasonspeoplegaveforbeingdissatisfiedwiththeNHSoverallwere:longwaitingtimes;staffshortages;alackoffunding;andmoneybeingwasted.

Satisfaction with NHS and social care services in 2018

• Satisfactionwithinpatientserviceswas63percent.Levelshavefluctuatedinrecentyears,butthe8percentagepointincreasefromthepreviousyeartakessatisfactiontoitshighestlevelsince1993.

• Satisfactionwithoutpatientserviceswas70percent.Again,levelshavefluctuatedinrecentyears,butthe5percentagepointincreasefromthepreviousyeartakessatisfactiontoitshighestlevelsincethesurveybegan.Forthefirsttime,outpatientswasthehighest-ratedserviceinthesurvey.

• Satisfactionwithbothinpatientandoutpatientserviceswashigheramongthosewhohaveusedthoseservicesrecentlyorhavefriendsandfamilymemberswhohavedoneso.

Keyfindings 4


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• Satisfactionwithaccidentandemergency(A&E)serviceswas53percent.Thechangeinsatisfactionfromthepreviousyearwasnotstatisticallysignificant.

• SatisfactionwithGPserviceswas63percent.Thechangeinsatisfactionfromthepreviousyearwasnotstatisticallysignificant,andsatisfactionremainsatitslowestlevelsincethesurveybeganin1983.

• SatisfactionwithNHSdentistryserviceswas58percent.Thechangeinsatisfactionfromthepreviousyearwasnotstatisticallysignificant.

• Satisfactionwithsocialcareserviceswas26percent.Again,thechangeinsatisfactionfromthepreviousyearwasnotstatisticallysignificant.

HowsatisfiedistheBritishpublicwiththeNHSoverall? 5


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1 How satisfied is the British public with the NHS overall?

Thisyear,theNHSembarksonimplementinganew10-yearplan,accompaniedbyitsmostgenerousfundingsettlementforalmostadecade,albeitbelowwhatwethinkisneededtomaintainandimproveservices(NHS England 2019;The King’s Fund et al 2017).Asitstartsthisnewchapter,theNHS’sreportcardismixed.Althoughitisoneofthemostequitablesystemsintheworld,itlagsbehindmanycomparablecountriesonkeyoutcomemeasuresfordiseaseslikecancer,strokeandheartattack,aswellaschildhoodmortality(Dayan et al 2018).SowhatdotheBritishpublicthinkabouttheNHSandhowhasthatchangedovertime?

For36years,theBSAsurveyhasaskedasampleofthepublic‘howsatisfiedareyouwiththewaytheNHSrunsnowadays?’In2018,publicsatisfactionwiththeNHSwas53percent;thiscombinespeoplewhosaytheyare‘very’and‘quite’satisfied(Figure1).Thisisa3percentagepointdropfromthepreviousyearandcontinuesadownwardtrendthattakessatisfactiontoitslowestlevelsince2007.

PublicdissatisfactionwiththeNHSwas30percentin2018.Thechangefrom2017wasnotstatisticallysignificantandthisisthehighestlevelofdissatisfactionwiththeNHSoverallsince2007.

http://www.longtermplan.nhs.uk/publication/nhs-long-term-plan/

http://www.kingsfund.org.uk/publications/autumn-budget-2017


http://www.kingsfund.org.uk/publications/nhs-70-how-good-is-the-nhs



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Question asked: ‘All in all, how satisfied or dissatisfied would you say you are with the way in which the National Health Service runs nowadays?’

Notes:Thisquestionwasnotaskedin1985,1988and1992;in2018,n=2926;‘Don’tknow’responsesarenotshown,in2018thisresponsecategorywasselectedbylessthan0.05percentofrespondents.

Source:TheKing’sFundandNuffieldTrustanalysisofNatCenSocialResearch’sBSAsurveydata

Figure 1 Public satisfaction with the NHS, 1983–2018

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Thisdatagivesitsrichestinsightswhenviewedoverdecadesratherthanyears.Takingthatlong-termview,Figure1showsthatthe2000swerecharacterisedbyincreasingsatisfaction,upby31percentagepointsoverthedecadefrom38percent(in2001)to70percent(in2010).Conversely,the2010sarecharacterisedbydecreasingsatisfaction;althoughlevelshavefluctuated(includinga12percentagepointslumpin2011,anda5percentagepointjumpin2014),thebroadtrendshowsafallinglevelofsatisfaction,whichin2018was16percentagepointslowerthanin2010.



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Public views of the NHS at 70

VariouspiecesofresearchconductedbyTheKing’sFundandNuffieldTrustfortheNHS’s70thbirthday–includingpollingandin-depthworkshops–exploredchangingpublicperceptionsoftheservice(Burkitt et al 2018;McKenna 2018).Despitefallinglevelsofsatisfactionwiththehealthservicein2018,therelationshipbetweenthepublicandtheNHSremainedstrong.

PeopleremainedstronglycommittedtothefoundingprinciplesoftheNHS–freeatthepointofdelivery,comprehensiveandavailabletoall,andfundedthroughtaxation.

Thepublicsaidtheirexpectationsoftheserviceweregenerallymetandtheyfeltthattheirexpectationswere,forthemostpart,realistic.Theyrecognisedthattheyhavearoletoplayinkeepinghealthybutwerealsosupportiveofspecificgovernmentinterventionsdesignedtopromotehealthybehaviours–suchasthesmokingbanandthesoftdrinksindustrylevy.

Alackoffundingaroseasakeyconcern–somethingthatisbackedupbyBSAdatacollectedin2017,whichshowsthatthevastmajorityoftheBritishpublicbelievedtheNHShadafundingproblem,andmostsaidthatiftheNHSneededmoremoney,theywouldbewillingtopaymoreintaxes(Evans 2018).Morerecentdataonthisfromthe2018BSAsurveywillbepublishedsoon.

Inlinewiththis,pollsconductedaftertheprimeminister’sannouncementofextramoneyfortheserviceinJune2018showedstrongsupportforafundingincreaseandforusingtaxrisestofundit(althoughataxrisewasnotultimatelynecessary)(NHS Confederation 2018;Smith 2018).

Foralargepartoftheyear,theNHSremainedneckandneckwithBrexitasthebiggestconcernforvoters,althoughafterthesummer,concernfortheNHSdroppedoffasBrexitworriesmovedtothefore(Ipsos MORI 2019).

http://www.kingsfund.org.uk/publications/public-and-nhs-whats-the-deal

http://www.kingsfund.org.uk/sites/default/files/2018-06/NHS_at_70_are_we_expecting_too_much_from_the_NHS.pdf

http://www.kingsfund.org.uk/publications/does-public-see-tax-rises-answer-nhs-funding-pressures

http://www.nhsconfed.org/media-centre/2018/06/ipsos-polling

https://yougov.co.uk/topics/politics/articles-reports/2018/07/03/majority-brits-now-support-increasing-income-tax-f

http://www.slideshare.net/IpsosMORI/ipsos-mori-issues-index-december-2018


WhoismostsatisfiedwiththeNHS? 8

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2 Who is most satisfied with the NHS?

Figure2showshowsatisfactiondiffersamongdifferentpopulationgroups.Foreachgroupwehaveincludedbarsshowingthe95percentconfidenceintervalaroundtheirlevelofsatisfaction.Thisistherangeofvaluesthat,basedonthesurveydata,wecanbe95percentcertainincludethetruesatisfactionlevelforeachgroup.Wheretheconfidenceintervalsoverlapbetweengroups,wecannotbeconfidentthatthetruesatisfactionlevelsdiffer.Asinpreviousyears,satisfactionlevelsdifferbyage:respondentsaged65andolderhavehigherlevelsofsatisfaction(61percent)thanthoseaged18–64(51percent).Andalthoughnotshownonthechart,thoseaged75andolderhaveanevenhigherlevelofsatisfaction(67percent).

Thereisalsoadifferenceinthesatisfactionlevelsreportedbysupportersofdifferentpoliticalparties.RespondentswhosupporttheConservativepartyhaveahigherlevelofsatisfaction(58percent)thanrespondentswhosupporttheLabourparty(51percent).ThisfollowsapatternseenintheBSAinmostyears,wherebysupportersofthepoliticalpartyinpower(ie,thepartythatiscurrently‘running’theNHS)reporthigherlevelsofsatisfactionthansupportersofthemainoppositionparty.

Althoughtherearedifferencesinthesatisfactionlevelsreportedbyothergroups,theyarenotstatisticallysignificant.Thismeansthatwecannotbeconfidentthatthetruelevelsofsatisfactionforthesegroupsactuallydiffer;thesurveyresultsmaybedowntochance.Figure2showsthattherearenostatisticallysignificantdifferencesinsatisfactionlevelsbetweenmenandwomen,acrossdifferentincomegroups,betweenpeopleofdifferentethnicities,andbetweenthosewhohaveandhavenothadrecentcontactwithNHSinpatientservicesinthepastyear.

Figure3showshowsatisfactionlevelsforeachpopulationgroupchangedbetween2017and2018.Satisfactionlevelsdecreasedformost,butalotofthosechangeswerenotstatisticallysignificant.Onthechart,thechangesthatarestatisticallysignificantaremarkedwitha‘v’.



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*thequestiononcontactwithinpatientserviceswasaskedofarandomthirdofthesample.Thissmallergrouphadalowerlevelofsatisfactionoverall,thanthefullsample:52percentin2017and50percentin2018.**nocontactbytherespondentortheirfamilyandfriends.***lowbasesizes,sotheresultsshouldbeviewedwithcaution.Blackn=91;Mixed/othern=56.


Figure 2 Percentage of respondents in different population groups who are ‘very’ or ‘quite’ satisfied with the NHS, 2018

Percentage ‘very’ or ‘quite’ satisfied 25 30 35 40 45 50 55 60 65 70 75

Age65+18–64

Political affiliationLiberalDemocratLabourConservativeNone

Recent contact with inpatient services*Nocontact**Friends/familycontactPersonalcontact

EthnicityWhiteAsianBlack***Mixed/other***

Household income (per month, before tax)£3,701+£2,201–3,700£1,201–£2,200<£1,200Refused

GenderMaleFemale

2018overallsatisfaction



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vdifferenceisstatisticallysignificantat5percentlevel,p<=0.05*nocontactbytherespondentortheirfamilyandfriends.**lowbasesizes,sotheresultsshouldbeviewedwithcaution.2018:Blackn=91;Mixed/othern=56;2017:Blackn=109;Mixed/othern=45


Figure 3 Change in percentage of respondents in different population groups who are ‘very’ or ‘quite’ satisfied with the NHS, 2017–2018

Between 2017 and 2018 the change

in satisfaction was statistically significant

for the four groups marked v

Change in satisfaction from 2017 to 2018, in percentage points -18 -16 -14 -12 -10 -8 -6 -4 -2 0 2 4 6

Age65+18–64

Political affiliationLiberalDemocratLabourConservativeNone

Recent contact with inpatient servicesNocontact*Friends/familycontactPersonalcontact

EthnicityWhiteAsianBlack**Mixed/other**

Household income (per month, before tax)£3,701+£2,201–3,700£1,201–£2,200<£1,200Refused

GenderMaleFemale

v

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WhyisthepublicsatisfiedordissatisfiedwiththeNHS? 11

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3 Why is the public satisfied or dissatisfied with the NHS?

WeknowthatpublicviewsabouttheNHSaredrivenbyarangeoffactors,andthattheprecisereasonsforchangesinpublicsatisfactionovertimearedifficulttopindown.However,since2015wehaveincludedquestionsthatexplorewhatliesbehindtheoveralllevelsofsatisfactionanddissatisfactionreportedinthesurvey.Thequestionsaskrespondentswhoareeither‘satisfied’or‘dissatisfied’withtheNHStoexplaintheiranswerbypresentingninepossiblereasonsandaskingthemtoselectuptothree.Thelistsofreasonsweredevelopedusinganswerstoanopen-endedquestionaboutwhyrespondentswereeithersatisfiedordissatisfied.

WhenweaskedrespondentswhoweresatisfiedwiththeNHSoveralltoexplaintheiranswer,themajoritysaidtheyweresatisfiedbecauseofthequalityofcare(71percent)andtheNHSbeingfreeatthepointofuse(62percent)(Figure4).Almosthalfsaidtheyweresatisfiedbecauseofthegoodrangeofservicesavailable(46percent)andtheattitudesandbehaviourofNHSstaff(44percent),andforalmostaquarter(23percent),thelengthofwaitingtimeswasafactor.



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Question asked: ‘You said you are satisfied with the way in which the National Health Service runs nowadays. Why do you say that? You can choose up to three answers.’(Optionspresentedonacard).Thisquestionwasaskedofarandomthirdofthosewhosaidtheywere‘quite’or‘very’satisfiedwiththewaytheNHSrunsnowadays,n=494


Figure 4 Reasons for satisfaction with the NHS overall, 2018

Percentage of respondents stating that they were ‘very’ or ‘quite’ satisfied 0 10 20 30 40 50 60 70 80 90 100

ThequalityofNHScare

NHScareisfreeatthepointofuse

GoodrangeofservicesandtreatmentsavailableontheNHS

AttitudesandbehaviourofNHSstaff

Don’thavetowaitlongforaGPorhospitalappointment

MoneyisspentwiselyintheNHS

GovernmentreformsthataffecttheNHS

HowmuchmoneythegovernmentspendsontheNHS

Storiesinthenewspapers,ontheradiooronTV

Other

Overthepastfouryears,respondentshaveselectedthesametopfivemainreasonsforbeingsatisfied(Figure5).Therehasbeenanincreaseintheproportionofrespondentswhocitequalityofcareasafactor,andadecreaseintheproportionwhosaythattheyaresatisfiedbecauseofshortwaitingtimesforaGPorhospitalappointment.



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Question asked: ‘You said you are satisfied with the way in which the National Health Service runs nowadays. Why do you say that? You can choose up to three answers.’(Optionspresentedonacard).

Thisquestionwasaskedofarandomthirdofthosewhosaidtheywere‘quite’or‘very’satisfiedwiththewaytheNHSrunsnowadays


Figure 5 Reasons for satisfaction with the NHS overall, 2015–2018

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NHS care is freeat the point

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Dissatisfactionisdrivenbyadifferentsetoffactors(Figure6).ThetopthreereasonsgivenbyrespondentswhoweredissatisfiedwiththeNHSrelatetoaccessandresourcing.Aroundhalfsaidtheyweredissatisfiedbecauseoflongwaitingtimes(53percent),notenoughstaffintheNHS(52percent)andgovernmentfundingfortheservice(49percent).Athird(33percent)identifiedwasteasareason,andoneinfive(20percent)citedgovernmentreformsasthereason.



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Forthepasttwoyears,aroundhalfofrespondentshaveselectedthreemainreasonstoexplaintheirdissatisfaction:longwaitingtimes,staffshortagesandconcernsaboutalackoffunding(Figure7).Lookingathowthedriversofdissatisfactionhavechangedsincethisquestionwasfirstintroducedin2015,theproportionofrespondentscitinglackoffundingandstaffhaveincreased,whereastheproportioncitingwaitingtimesremainedconstant.

AsmallerproportionofrespondentscitedmoneybeingwastedintheNHSandgovernmentreformsthroughoutthisperiod.Butwhile2017sawajumpintheproportionofrespondentscitinggovernmentreformsasareason,andaslumpintheproportionofrespondentscitingwasteasareason,thelatestdatashowsthesereasonsreturningtolevelssimilartothosereportedin2015and2016.

Question asked: ‘All in all, how satisfied or dissatisfied would you say you are with the way in which the National Health Service runs nowadays? Why do you say that? You can choose up to three answers.’(Optionspresentedonacard).’

Thisquestionwasaskedofarandomthirdofthosewhosaidtheywere‘quite’or‘very’ withthewaytheNHSrunsnowadays,n=305


Figure 6 Reasons for dissatisfaction with the NHS overall, 2018

Percentage of respondents stating that they were ‘very’ or ‘quite’ dissatisfied 0 10 20 30 40 50 60 70 80 90 100

IttakestoolongtogetaGPorhospitalappointment

TherearenotenoughNHSstaff

Thegovernmentdoesn’tspendenoughmoneyontheNHS

MoneyiswastedintheNHS

GovernmentreformsthataffecttheNHS

ThequalityofNHScare

SomeservicesortreatmentsarenotavailableontheNHS

AttitudesandbehaviourofNHSstaff

Storiesinthenewspaper,ontheradiooronTV

Other

dissatisfied



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Veryfewpeoplesaidtheirsatisfactionordissatisfactionwasdrivenbystoriesinthemedia–despitewidespreadmediacoverageabouttheNHS’s70thbirthdayandaboutpressuresontheservice(seeFigure8).However,previousstudieshaveidentifiedlinksbetweenpubliclevelsofsatisfactionwiththeNHSandmediacoverage(JudgeandSolomon1993;Judgeet al1992).Itmaybethatmediastorieshaveanindirectimpactonunderlyingattitudes,whichisnotimmediatelyobvioustotherespondent.

Question asked: ‘You said you are dissatisfied with the way in which the National Health Service runs nowadays. Why do you say that? You can choose up to three answers.’(Optionspresentedonacard).

Thisquestionwasaskedofarandomthirdofthosewhosaidtheywere‘quite’or‘very’dissatisfiedwiththewaytheNHSrunsnowadays


Figure 7 Reasons for dissatisfaction with the NHS overall, 2015–2018

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Figure 8 Media coverage of the NHS and social care during 2018

ByFebruary,newsofthecrisisreachedTheWhiteHouse.PresidentDonaldTrumptweetedthattheNHSwas‘goingbroke’,aclaimswiftlyrefutedbyNHSChiefExecutiveEngland,SimonStevens.

InthefirstweekofJanuary 2018,journalistswerereportingacrisisintheNHSasA&Eunitsstruggledwithasurgeofpatientsneedingtreatmentandovercrowded

hospitalswereforcedtocancelplannedoperations.

JAN2018 FEB

MAR

APR

InOctober,newsemergedthatawastedisposalcompanyhadfailedtodisposeoftonnesofclinicalwastefromNHStrusts,triggeringameetingofthegovernment’semergencyCobracommittee.

Followingmonthsofmediacoverage,thePrimeMinisterrespondedtopressure,announcinga£20billionboostforthehealthserviceinJune.

InMarchministershailedtheendofausterityastheyannouncedadealtoincrease

thepayofmorethanonemillionNHSworkers.

InJuly,theNHSwasmarkingits70thanniversary,withextensivecoverageinthenewspapersandontelevision,includingalivestudiodebateontheBBC.The70thbirthdayoftheadventofthesocialcaresystembarelyregisteredamongstthenation’smedia.

CallstoincreaseNHSspendinggrewlouderinAprilandMayasthepressuresontheservicecontinuedandadebateaboutwhethertoincreasetaxationtopayforafunding

boostwasconductedthroughthemedia.

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OCT TheCabinetOfficeBriefingRooms(COBRA)


HowsatisfiedistheBritishpublicwithdifferentNHSandsocialcareservices? 17

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4 How satisfied is the British public with different NHS and social care services?

Since1983,theBSAsurveyhasalsoaskedtheBritishpublichowsatisfiedtheyarewithNHSgeneralpractice,dentistry,inpatientandoutpatientservices–and,morerecently,A&Eservices(since1999)andlocalauthoritysocialcareservices(since2005).Manyoftheserespondentswillnothaverecentlyusedalltheservicesthattheyarebeingaskedtocommenton,sotheresultsarelikelytoreflecttheexperiencesoffamilyandfriendsandinformationfromothersourcessuchasthemedia,aswellaspersonalexperienceforthosethathaveusedthem.

Thatsaid,theGPsatisfactionmeasureistheclosestthesurveygetstoameasurebasedondirectpersonalexperience,asmostpeoplewillhavevisitedtheirGPinthepastyearforeitherthemselvesorafamilymember(NHS Digital 2009).

In2018,satisfactionwithNHSgeneralpracticeserviceswas63percent.Thechangefromthepreviousyearwasnotstatisticallysignificantandsatisfactionremainsatitslowestlevelsincethesurveybeganin1983.Lookingoverthelongerterm,satisfactionhasdecreasedby16percentagepointssince2009,whenitwas80percent(Figure9).Dissatisfactionwithgeneralpracticein2018remainsatitshighestlevelsincethesurveybegan.Almostaquarter(24percent)ofrespondentsreportedbeingdissatisfiedwiththeirGPservice–doublethelevelofdissatisfactionreportedin2009.

NHSEngland’snationalGPpatientsurvey(whichcoversEngland,ratherthanGreatBritain)includesquestionsthatprovideausefultriangulationfortheBSAsurvey(Ipsos MORI and NHS England 2018).PatientsregisteredwithaGPareaskedhowtheywouldratetheirexperienceoftheirGPpracticeoverall,andtheproportionratingitas‘good’(‘very’+‘fairly’)hassteadilydecreasedfrom88percentin2012

https://digital.nhs.uk/data-and-information/publications/statistical/trends-in-consultation-rates-in-general-practice/trends-in-consultation-rates-in-general-practice-1995-2009

http://www.gp-patient.co.uk/surveysandreports



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to84percentin2018.Similarly,theproportionwhoratedtheiroverallexperienceofmakinganappointmentasgoodhasdecreasedfrom79percentin2012to69percentin2018.1

1Changesweremadetothissurveyin2018,whichmeantrendsbetween2017and2018shouldbetreatedwithcaution.Althoughthetwoquestionsreportedhereremainbroadlyunchanged,otherquestionsinthesurveywereamendedandthismayhavehadanimpactonresponses.

Questions asked: GP satisfaction: ‘From your own experience, or from what you have heard, please say how satisfied or dissatisfied you are with the way in which each of these parts of the National Health Service runs nowadays. First, local doctors or GPs?’Thisquestionwasnotaskedin1984,1985,1988,1992and1997; NHS dentistry satisfaction: …National Health Service dentists?’Thisquestionwasnotaskedin1984,1985,1988,1992and1997; Overall satisfaction: ‘All in all, how satisfied or dissatisfied would you say you are with the way in which the National Health Service runs nowadays?’Thisquestionwasnotaskedin1985,1988and1992.


Figure 9 Public satisfaction with NHS GP services, NHS dentistry services and the NHS overall, 1983–2018

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ManyofthosewhorespondedtothesurveywillhavevisitedanNHSdentistfairlyrecently.DatafromNHSDigitalshowsthathalfofadultsinEnglandsawanNHSdentistoveratwo-yearperiodtoJune2018(NHS Digital 2018).ChangesinsatisfactionwithNHSdentistryfollowaverydifferentpatterntosatisfactionwithGPservices(Figure9).In2018,satisfactionwithdentistrywas58percent,andtheincreasefromthepreviousyearwasnotstatisticallysignificant.SatisfactionwithNHSdentistryhasincreasedby15percentagepointssince2008.Therelativelyhighratesofsatisfactioncomparedtothemid-2000sarelikelytobepartlyexplainedbyeffortstoincreaseaccesstoNHSdentistryservicesoverthepastdecade.

Satisfactionwithsocialcareservicesprovidedbylocalauthoritieswas26percentin2018,withnostatisticallysignificantchangeinsatisfactionsince2015.Dissatisfactionwithsocialcareserviceswas34percentin2018–a7percentagepointdecreasefromthepreviousyear,takingdissatisfactionbacktolevelssimilartothosereportedin2016and2015.

Wheninterpretingtheseresults,itisimportanttotakeintoaccountthelackofpublicunderstandingaboutsocialcareservicesandaboutwhichservicesarefundedbylocalauthorities(asopposedtothosepurchasedprivately),aswellasthefactthatmostrespondentswillnothaveanyexperienceofusingthoseservices(Bottery et al 2018).Thiscontributestoahigherproportionofrespondentsgivinganeutralor‘don’tknow’answertothesatisfactionquestionthanforotherservices(seeFigure13).DataonthequalityofsocialcareservicesfromtheCareQualityCommission(CQC)suggeststhatratingsmaybeimproving,butaccesstoservicesisincreasinglysqueezedaslocalauthoritiestightenentitlements(Thorlby et al 2018;Care Quality Commission 2014).

Thesurveyquestionaboutsocialcareserviceshasbeenaskedsince2005,althoughthefirsttwoyears’dataisbasedonaquestionwithslightlydifferentwording,whichdoesnotmentionlocalauthoritiesinitsdefinitionofsocialcare(seenotesunderFigure10formoredetailonquestionwording).

https://digital.nhs.uk/data-and-information/publications/statistical/nhs-dental-statistics/2017-18-annual-report

http://www.kingsfund.org.uk/publications/fork-road-social-care-funding-reform

http://www.kingsfund.org.uk/publications/nhs-70-whats-the-problem-with-social-care

http://www.gov.uk/government/publications/the-state-of-health-care-and-adult-social-care-in-england-201314



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Thesurveyalsoasksaboutsatisfactionwithinpatientandoutpatientservices,bothofwhichincreasedin2018(Figure11).

Satisfactionwithinpatientserviceswas63percent–thehighestlevelofsatisfactionsince1993.Levelshavefluctuatedoverthepastthreeyears:the8percentagepointincreasein2018takessatisfactionbacktoalevelsimilarto2016.Dissatisfactionwithinpatientserviceswasjust9percent–adropof5percentagepointsfromthepreviousyearandthelowestlevelofdissatisfactionsince1983.

Social care satisfaction: Questions asked: ‘And how satisfied or dissatisfied are you with social care provided by local authorities for people who cannot look after themselves because of illness, disability or old age?’[2012–2018], ‘At some point in their lives people can need regular help looking after themselves because of illness, disability or old age… From your own experience, or from what you have heard, please say how satisfied or dissatisfied you are with the services provided to people who need this kind of regular help with looking after themselves, whose family cannot provide it?’[2005,2007].Questionnotasked2006and2008–2011.

Overall satisfaction: ‘All in all, how satisfied or dissatisfied would you say you are with the way in which the National Health Service runs nowadays?’


Figure 10 Satisfaction with social care services and the NHS overall, 2005–2018

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2005 201720162015201420132012201020082006 2007 2009 2011 2018



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Satisfactionwithoutpatientserviceswas70percentin2018–thehighestlevelsincethesurveybeganin1983.Aswithinpatientservices,satisfactionlevelshavefluctuatedoverthepastthreeyears:the5percentagepointincreasein2018takessatisfactionbacktoalevelsimilarto2016.Dissatisfactionwithoutpatientserviceswas11percent,andthechangefromthepreviousyearwasnotstatisticallysignificant.

SatisfactionwithA&Eservices(53percentin2018)hasnotchangedsignificantlysince2015.

Questions asked: ‘From your own experience, or from what you have heard, please say how satisfied or dissatisfied you are with the way in which each of these parts of the National Health Service runs nowadays… being in hospital as an inpatient?… attending hospital as an outpatient?… accident and emergency departments?’;Overallsatisfaction: ‘All in all, how satisfied or dissatisfied would you say you are with the way in which the National Health Service runs nowadays?’

Questionsaboutoutpatients,inpatientsandtheNHSoverallwerenotaskedin1984,1985,1988,1992;questionsonoutpatientsandinpatientswerenotaskedin1997;questionsonaccidentandemergencywerefirstaskedin1999.


Figure 11 Satisfaction with NHS inpatient, outpatient and accident and emergency services, 1983–2018

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ThedataonsatisfactionwithinpatientservicesshowsasimilartrendtothenationalNHSinpatientsurvey,whichwasconductedin2017(resultsofthe2018surveyareyettobepublished)(CQC 2018).WhenaskedtoratetheirexperienceofNHSinpatientservicesoverallonascaleof0(verypoor)to10(verygood),almosthalfofrespondentsgaveascoreof9or10–afigurethathasbeengraduallyincreasingsincethequestionwasfirstintroducedin2012.Thelatestemergencydepartmentnationalpatientsurveyresultsfrom2016alsoshowthataroundhalfofpatientsgivetheserviceanoverallratingof9or10,butchangestothesurveysamplingandanalysisapproachmeanthatthisdatacannotbecomparedtopreviousyears(CQC 2017).Thereisnorecentnationalpatientsurveydataonoutpatientservicesagainstwhichtocomparethesemeasures.

ThetrendofincreasingsatisfactionwithinpatientandoutpatientservicesisstrikinggiventhatoverallsatisfactionwiththeNHShasbeenfallinginrecentyears.PublicsatisfactionsurveysliketheBSAoftenfindthatthepublicgivedifferentratingswhentheyareaskedabouttheNHSingeneraltowhentheyareaskedaboutspecificservices,andtheformerisnotasumoftheirviewsonthelatter.Itisbeyondthescopeofthissurveytorevealtheunderlyingreasonsfortheassociationsbetweenthesedifferentsatisfactionmeasures,butitisworthbearinginmindthatrespondentsarelikelytobeconsideringarangeofdifferentfactorsandgivingdifferentweightingstoeachwhenexpressingsatisfactionwithindividualservicesandtheNHSoverall(Wellings 2012).

Onefactorthatweknowaffectssatisfactionratingsforhospitalservicesisrecentexperienceofusingtheservice(Figure12).Asinpreviousyears,thelatestsurveyshowsthatsatisfactionwithinpatientserviceswashigheramongthosewhohadusedinpatientservicesinthepastyear(83percent)thanamongthosewhohadnotusedtheservicethemselvesbuthadfriendsandfamilywhohad(69percent),andsatisfactionwasevenloweramongthosewhohadhadnocontactwithinpatientserviceseitherthemselvesorthroughtheirfriendsandfamily(57percent).Responsesaboutoutpatientservicesfollowasimilarpattern(Figure12).

Thesedifferencesremainwhenageistakenintoaccount.So,forexample,peopleagedover65whohadbeenanNHSinpatientrecentlyweremoresatisfiedthanpeopleinthesameagegroupwhohadnothadrecentexperienceoftheservice.

http://www.nhssurveys.org/surveys/1223

http://www.cqc.org.uk/publications/surveys/emergency-department-survey-2016

http://www.nuffieldtrust.org.uk/news-item/beyond-the-headlines-what-is-happening-with-nhs-satisfaction-rates



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Thesurveydoesnottelluswhatliesbehindthesedifferences,butthefindingsatleastsuggestthatpeoplewhousehospitalserviceshavepositivefeelingsabouttheexperience(bethatbecauseofthequalityofcaretheyreceive,feelingsofgratitudefortheserviceorotherthings)andthiscontributestothemreportinghigherlevelsofsatisfaction.Thosewithnoexperienceoftheservicemaydrawonadifferentsetofinformationsourceswhendecidingontheirlevelofsatisfaction.Theirmorenegativeresponsesmight,forexample,bemoreinfluencedbystoriesabouthospitalsinthemedia,whichtendtobenegative(Pinker 2018).

Questions asked: ‘In the last twelve months, have you or a close family member or close friend… been an out-patient/in-patient in an NHS hospital?[Yes,justme,Yes,notmebutclosefamilymemberorfriend,Yes,bothmeandclosefamilymemberorfriend,No,neither’]; ‘From your own experience, or from what you have heard, please say how satisfied or dissatisfied you are with the way in which each of these parts of the National Health Service runs nowadays… being in hospital as an inpatient?… attending hospital as an outpatient?…


Figure 12 Satisfaction with NHS inpatient and outpatient services by recent contact with the service, 2018

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http://www.theguardian.com/commentisfree/2018/feb/17/steven-pinker-media-negative-news



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Figure13bringstogetherpublicsatisfactiondataforhealthandsocialcareservicesandtheNHSoverallin2018.ItshowsthatsatisfactionwithoutpatientservicesishigherthanforallotherservicesincludedinthesurveyandfortheNHSoverall.Thisisthefirsttimesincethesurveybeganin1983thataserviceotherthangeneralpracticehasreceivedthehighestsatisfactionratings(althoughin2017GPandoutpatientserviceshadthesamelevelofsatisfaction).Thisistheresultoffallinglevelsofsatisfactionwithgeneralpracticeandincreasinglevelsofsatisfactionwithoutpatientservices.

Questions asked: ‘From your own experience, or from what you have heard, please say how satisfied or dissatisfied you are with the way in which each of these parts of the National Health Service runs nowadays. First, local doctors or GPs?… National Health Service dentists?’ …being in hospital as an inpatient?… attending hospital as an outpatient?… accident and emergency departments?’ ‘And how satisfied or dissatisfied are you with social care provided by local authorities for people who cannot look after themselves because of illness, disability or old age?’;Overallsatisfaction: ‘All in all, how satisfied or dissatisfied would you say you are with the way in which the National Health Service runs nowadays?’


Figure 13 Satisfaction with NHS and social care services, 2018

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Asinpreviousyears,satisfactionwiththesocialcareservicesprovidedbylocalauthoritiesisfarlowerthansatisfactionwithhealthcareservices.

Whenrespondingtothequestiononsocialcare,40percentofrespondentssaidthatthey‘don’tknow’howsatisfiedtheyare,orprovideaneutralanswer(‘neithersatisfiednordissatisfied’).Thisishigherthanforotherservices,wherethefigurerangesfrom13percentto29percent,andislikelytoreflectalowerlevelofunderstandingamongthepublicaboutwhatsocialcareservicesare,coupledwithlessexperienceofusingthem(Bottery et al 2018).

In2018,netsatisfactionwithsocialcareservices(calculatedassatisfactionminusdissatisfaction)was-8percent,whereasnetsatisfactionwiththeNHSoverallandindividualNHSservicesrangedfrom23percentto59percent.



Conclusion 26

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5 Conclusion

In2018,theoutpouringofaffectionthataccompaniedtheNHS’s70thbirthdaydidnotstemfallinglevelsofpublicsatisfactionwiththeservice.SatisfactionwiththeNHSsitsatitslowestlevelformorethanadecade,drivenbyconcernsaboutalackofmoney,staffshortagesandmountingwaitingtimes.ThenewfundingsettlementfortheNHSandaccompanyinglong-termplanhavesetthedirectionoftravelforthenext10years,butwithless-firmcommitmentstoreducingwaitingtimesthantherewereinthepast,andthegovernment’sstrategyfordealingwithcriticalworkforceissuesstilloutstanding,wemustwaittoseewhenthedecade-longslideinpublicsatisfactionwiththeNHSwillcometoanend.

Appendix:Methodology 27


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Appendix: MethodologySample and approach

The2018surveyconsistedof3,879interviewswitharepresentativesampleofadultsinEngland,ScotlandandWales.AddressesareselectedatrandomandvisitedbyoneofNatCenSocialResearch’sinterviewers.Afterselecting(againatrandom)oneadult(aged18orover)attheaddress,theinterviewercarriesoutanhour-longinterview.Theparticipantanswersmostquestionsbyselectingananswerfromasetofcards.

ThesamplesizefortheoverallNHSsatisfactionquestionreportedherewas2,926in2018;forquestionsaboutsatisfactionwithotherNHSservicesandsocialcareservices,thesamplesizewas973.Thedataisweightedtocorrectfortheunequalprobabilitiesofselection,andforbiasescausedbydifferentialnon-response.Theweightedsampleiscalibratedtomatchthepopulationintermsofage,sexandregion.Themarginoferrorin2018forthehealthcarequestionswasaround+/-1.5to3.7percentagepoints.

Themajorityoffieldworkforthe2018surveywasconductedbetweenJulyandOctober,withasmallnumberofinterviewstakingplaceinNovember.

Topics

Thetopicscoveredbythesurveychangefromyeartoyear,dependingontheidentitiesandinterestsofitsfunders.Somequestionsareaskedeveryyear,someareaskedeverycoupleofyearsandsomeareaskedlessfrequently.

Funding

Thesurveyisfundedbyarangeofcharitableandgovernmentsources,whichchangefromyeartoyear.ThesurveyisledbyNatCenSocialResearch.NatCencarriesoutresearchinthefieldsofsocialandpublicpolicy.

References 28


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ReferencesBotteryS,VarrowM,ThorlbyR,WellingsD(2018).A fork in the road: next steps for social care funding reform. The costs of social care funding options, public attitudes to them – and the implications for policy reform.London:TheKing’sFundandHealthFoundation.Availableat:www.kingsfund.org.uk/publications/fork-road-social-care-funding-reform(accessedon13February2019).

BurkittR,DuxburyK,EvansH,EwbankL,GregoryF,HallS,WellingsD,WenzelL(2018).The public and the NHS: what’s the deal?London:TheKing’sFund.Availableat:www.kingsfund.org.uk/publications/public-and-nhs-whats-the-deal(accessedon13February2019).

CareQualityCommission(2018).2017 Adult inpatient survey statistical release.Newcastle:CareQualityCommission.Availableat:www.nhssurveys.org/surveys/1223(accessedon13February2019).

CareQualityCommission(2017).2016 Emergency department survey statistical release.Newcastle:CareQualityCommission.Availableat:www.cqc.org.uk/publications/surveys/emergency-department-survey-2016(accessedon13February2019).

CareQualityCommission(2014).The state of health care and adult social care in England 2013/14.HC691.London:StationeryOffice.Availableat:www.gov.uk/government/publications/the-state-of-health-care-and-adult-social-care-in-england-201314(accessedon13February2019).

DayanM,WardD,GardnerT,KellyE(2018).How good is the NHS?London:TheKing’sFund,NuffieldTrust,HealthFoundationandInstituteforFiscalStudies.Availableat:www.kingsfund.org.uk/publications/nhs-70-how-good-is-the-nhs(accessedon13February2019).

EvansH(2018).‘DoesthepublicseetaxrisesastheanswertoNHSfundingpressures?’TheKing’sFundwebsite.Availableat:www.kingsfund.org.uk/publications/does-public-see-tax-rises-answer-nhs-funding-pressures(accessedon13February2019).

IpsosMORI(2019).Ipsos MORI issues index December 2018[online].IpsosMORIwebsite.Availableat:www.slideshare.net/IpsosMORI/ipsos-mori-issues-index-december-2018(accessedon13February2019).

IpsosMORI,NHSEngland(2018).‘GPpatientsurveynationalreport’.GPpatientsurveywebsite.Availableat:www.gp-patient.co.uk/surveysandreports(accessedon13February2019).

JudgeK,SolomonM,MillerD,PhiloG(1992).‘Publicopinion,theNHS,andthemedia:changingpatternsandperspectives’.BMJ (Clinical research ed.),vol304,no6831,pp892–895.




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http://www.slideshare.net/IpsosMORI/ipsos-mori-issues-index-december-2018

http://www.gp-patient.co.uk/surveysandreports

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JudgeK,SolomonM(1993).‘PublicopinionandtheNationalHealthService:patternsandperspectivesinconsumersatisfaction’.Journal of Social Policy,vol22,no3,pp299–327.

McKennaH(2018).Are we expecting too much from the NHS?London:HealthFoundation,InstituteforFiscalStudies,TheKing’sFundandNuffieldTrust.Availableat:www.kingsfund.org.uk/sites/default/files/2018-06/NHS_at_70_are_we_expecting_too_much_from_the_NHS.pdf(accessedon13February2019).

NHSConfederation(2018).‘Overwhelmingmajorityofpublicsupportsspendingincreasetofundimprovedhealthcare’Newsrelease.London:NHSConfederation.Availableat:www.nhsconfed.org/media-centre/2018/06/ipsos-polling(accessedon13February2019).

NHSDigital(2018).NHS dental statistics for England – 2017–18, annual report.London:NHSDigital.Availableat:https://digital.nhs.uk/data-and-information/publications/statistical/ nhs-dental-statistics/2017-18-annual-report(accessedon13February2019).

NHSDigital(2009).Trends in consultation rates in general practice – 1995–2009.London:NHSDigital.Availableat:https://digital.nhs.uk/data-and-information/publications/statistical/trends-in-consultation-rates-in-general-practice/trends-in-consultation-rates-in-general-practice-1995-2009(accessedon13February2019).

NHSEngland(2019).The NHS long term plan.London:NHSEngland.Availableat:www.long termplan.nhs.uk/publication/nhs-long-term-plan/(accessedon13February2019).

PinkerS(2018).‘Themediaexaggeratesnegativenews.Thisdistortionhasconsequences’.The Guardian,17February.Availableat:www.theguardian.com/commentisfree/2018/feb/17/steven-pinker-media-negative-news(accessedon13February2019).

SmithM(2018).A majority of Brits now support increasing income tax to fund the NHS.London:YouGov.Availableat:https://yougov.co.uk/topics/politics/articles-reports/2018/07/03/majority-brits-now-support-increasing-income-tax-f(accessedon13February2019).

TheKing’sFund,NuffieldTrust,HealthFoundation(2017).The autumn budget: joint statement on health and social care.London:TheKing’sFund.Availableat:www.kingsfund.org.uk/publications/autumn-budget-2017(accessedon13February2019).

ThorlbyR,StarlingA,BroadbentC,WattT(2018).What’s the problem with social care, and why do we need to do better?London:TheKing’sFund.Availableat:www.kingsfund.org.uk/publications/nhs-70-whats-the-problem-with-social-care(accessedon13February2019).

WellingsD(2012).‘Beyondtheheadlines:whatishappeningwithNHSsatisfactionrates?’NuffieldTrustBlog.Availableat:www.nuffieldtrust.org.uk/news-item/beyond-the-headlines-what-is-happening-with-nhs-satisfaction-rates(accessedon13February2019).



http://www.nhsconfed.org/media-centre/2018/06/ipsos-polling

















Acknowledgements 30


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AcknowledgementsManythankstoEleanorAttarTaylor,SivaAnandacivaandDavidMaguirefortheirassistancewithdataanalysis,toAndrewMcCrackenforhisanalysisofmediastoriesduringthefieldperiod,andtoallofourcolleaguesatTheKing’sFundandNuffieldTrustwhoprovidedhelpfulcommentsonearlierdraftsandhelpedwiththeediting,digitalcontentandlaunchofthisreport.MostimportantlywewouldliketothankmembersoftheBritishpublicforthetimetheytooktocompletethissurveyandforprovidinguswiththisfascinatingdataset.

Abouttheauthors 31


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About the authorsRuth Robertson

RuthworksinthepolicyteamwheresheleadsresearchprojectsonawiderangeofNHSpolicyissues.Recently,thesehaveincludedthedevelopmentofclinicalcommissioninggroups,thequesttogetbettervaluefromtheNHSbudgetandtheimpactofNHSfinancialpressuresonpatients.

BeforereturningtoTheKing’sFundin2013,RuthspentthreeyearsattheCommonwealthFundinNewYorkresearchingtheimplementationoftheAffordableCareActanditsimpactontheuninsured.ShepreviouslyworkedatTheKing’sFundbetween2006and2010,whenshecompletednationalevaluationsoftwoofLabour’smajorhealthsystemreforms:patientchoiceandpractice-basedcommissioning.EarlierinhercareerRuthworkedasananalystattheCommissionforHealthImprovement(apredecessortotheCareQualityCommission)andasamedicalsecretaryatvariousNHStrusts.

John Appleby

JohnApplebyjoinedtheNuffieldTrustasDirectorofResearchandChiefEconomistinSeptember2016,after18yearsatTheKing’sFund.

HeisaVisitingProfessorattheCityHealthEconomicsCentre,CityUniversityLondonandVisitingProfessorattheInstituteofGlobalHealthInnovationatImperialCollege.

JohnhaspreviouslyworkedintheNHSinBirminghamandLondon,andasseniorlecturerattheuniversitiesofBirminghamandEastAnglia.ForfiveyearsheworkedfortheNationalAssociationofHealthAuthorities(nowtheNHSConfederation)asmanageroftheAssociation’sCentralPolicyUnit.

JohnhasactedasanadvisortotheUKgovernmentandParliamentinvariouscapacities,forexample,carryingoutareviewforMinistersofthefuturefundingneedsofNorthernIreland’shealthservice,andasataskforcememberforthe

Abouttheauthors 32


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MarmotCommissiononhealthinequalities;aspecialadvisertotheHouseofCommonsHealthSelectCommittee,memberoftheNationalQualityBoard’sPrioritiessub-committeeandasamemberoftheDepartmentofHealth’sStakeholderReferenceGrouponpatientreportedoutcomemeasures.

Harry Evans

Harryisaresearcherinthepolicyteam.BeforejoiningtheFundin2016,HarryworkedforthreeyearsatIpsosMORI’sSocialResearchInstitute,focusingonhealthresearch,workingwitharangeofhealthsectororganisations,includingNHSEnglandandtheDepartmentofHealth.AtIpsosMORI,HarryworkedontheGPPatientSurvey,andalsohadaspecialinterestinspeakingtothepublicabouttheirhealthdataandinemerginghealthtechnologies.

HeholdsaMastersinEuropeanlanguage,cultureandhistoryfromUCL.

Nina Hemmings

NinajoinedtheNuffieldTrustasaResearcherinHealthPolicyinJanuary2018.SheprovidessupportacrossthePolicyteamonarangeofqualitativeprojectsrelatingtohealthandsocialcare.

PriortojoiningtheTrustNinaworkedasaPolicyOfficerleadingonNHSfinancesatNHSProviders,andasCoordinatorfortheObesityHealthAlliance(acoalitiongroupcomprisingover30royalmedicalcollegesandnationalcharities).Shehasspecialinterestsinadultsocialcare,childrenandyoungpeople,andmentalhealth.

NinaholdsanMScinComparativeSocialPolicyfromtheUniversityofOxford,andaBAinArchaeologyandAnthropology.


TheKing’sFundisanindependentcharityworkingtoimprovehealthandcareinEngland.Wehelptoshapepolicyandpracticethroughresearchandanalysis;developindividuals,teamsandorganisations;promoteunderstandingofthehealthandsocialcaresystem;andbringpeopletogethertolearn,shareknowledgeanddebate.Ourvisionisthatthebestpossiblehealthandcareisavailabletoall.

www.kingsfund.org.uk @thekingsfund

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Published byTheKing’sFund11–13CavendishSquareLondonW1G0ANTel:02073072568Fax:02073072801

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Firstpublished2019byTheKing’sFund

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EditedbyKathrynO’Neill

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Since1983,NatCenSocialResearch’sBritishSocialAttitudes(BSA)surveyhasaskedmembersofthepublicinEngland,ScotlandandWalesabouttheirviewsontheNHSandhealthandcareissuesgenerally.ThelatestsurveywascarriedoutbetweenJulyandOctober2018andaskedrespondentsabouttheirsatisfactionwiththeNHSoverallandindividualNHSandsocialcareservices.

ThisreportfromTheKing’sFundandNuffieldTrustanalysestheresultsofthesurvey,lookingatthechanginglevelsofsatisfactionwiththeNHSandsocialcareandthefactorsthataffectsatisfaction.

TheKing’sFund11–13CavendishSquareLondonW1G0ANTel:02073072568

Charityregistrationnumber:1126980

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public satisfaction with the nhs and social care in 2018 · introduction 2 public satisfaction with...

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