The closest thing Britain still has to a religion

It’s an understatement to say that 2015 has been tough for the NHS. The first three months saw A&E waiting times reach their highest point in a decade, only to move to gloomy coverage of an NHS facing its greatest ever funding crisis. The year ended with a very public row about junior doctors, and nearly all trusts forecasting a deficit – an almost unprecedented position.

But despite this picture of instability, the public remain overwhelmingly positive about the health service. Satisfaction remains high, with 67% saying they are satisfied with the running of the NHS, and as many as 85% in our GP Patient Survey saying that their overall experience of their GP practice is good.

Simultaneously, the public are worried about what lies ahead. The majority expect there to be a severe funding crisis in the future (85%), and expectations of future quality in the NHS are low, with over half saying they expect it to get worse over the next few years (55%), the highest level of pessimism we have ever recorded.

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Given the real pressures on services, the turmoil of 2015 surely means we have reached a crunch point in public opinion, doesn’t it? Actually, 2015 may have been tough for the NHS, but this gap between satisfaction and future expectations characterises previous years; satisfaction has consistently been above 65% since 2008, while concern about future funding has consistently been above 80% since 2010.

What is strange, then, is that satisfaction hasn’t already started to fall. If concern about the future has been high for at least the last five years, we might have expected current satisfaction to be starting to show a decline by now.

So why haven’t we?

Ultimately, the NHS continues to deliver, despite the challenges. If you turn up at A&E, you get seen, even if you have to wait longer. The NHS keeps on treating people day after day, fixing them, curing them and sending them home better. We know that the public trust the NHS to do this; they’re not unduly worried about safety, or questioning whether clinical outcomes are as good as they could be (even if they should). Of course these things are difficult for the public to judge, so they tend to focus on the more visible things, like access and waiting times – convenience simply resonates with them more than quality or safety. Our data show this. When we asked people about why seven day services might be introduced, 36% said that convenient appointment times were behind the policy and the same proportion mentioned a lack of appointments. In contrast, many fewer people believed that improving quality at the weekend (27%) or too many deaths among those admitted at the weekend (14%) were behind it.

However, satisfaction and expectations of services are not the same thing – it’s very possible that the constant stories of impending doom are in fact lowering expectations, but not satisfaction. Perhaps the public of 2015 are simply prepared to accept less because they know that the NHS is creaking at the seams and are therefore grateful for any care they receive. We know that the public have very complex feelings about the NHS; they’re proud of it and support the principles on which it was founded (60% strongly agree). Maybe then, they are satisfied as long as it’s good enough, and it’s better than the alternative.

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What does this mean for what lies ahead in 2016? Perhaps we will still have a public that is satisfied, while also being incredibly worried about what’s to come? Or perhaps satisfaction will drop? There are some limited signs of this shift, with more people thinking health and social care services have deteriorated than in 2013. This doesn’t necessarily mean that satisfaction is decreasing – you can still be satisfied with a service that has got worse. Perhaps more an indication that satisfaction could be starting to shift is the fact satisfaction with GPs has fallen by four percentage points since 2012, despite still being high. Will it be, then, that 2016 sees expectations of services drop further and satisfaction follow suit? What could this mean for the public, the NHS and policy makers? Will 2016 see junior doctors joined on the streets by the general public? Current trends suggest it will happen at some point in this parliament.