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Expert Comment: Focusing On Public Expectations - The Case Of The NHS in 2012

NHS Tuesday 12 June 2012

Liverpool Hope's Senior Quality Advisor, Dr Katherine Birch, looks at the recent falls in public satisfaction with the NHS.

As recent results from the British Social Attitudes Survey[1] released today (12/6/12) highlight, public satisfaction in the NHS is falling - from 70 per cent in 2010 to 58 per cent in 2011. The latest survey, carried out over the summer of 2011, provides an important snapshot of satisfaction with the way in which the NHS runs and with specific aspects of service provision, such as general practice, inpatients and outpatients.

It is important to note that, despite the headlines which focus on the dramatic decline in reported satisfaction, this level of satisfaction remains the third highest since 1983, although the 12% drop is the largest single dip since the British Social Attitudes survey started. The results also show rises in dissatisfaction – from an all-time low of around 18 per cent in 2010 to 24 per cent. Of course, ‘satisfaction’ is a relative concept that may change as people’s expectations about the NHS change. If expectations about what comprises a good service increase, satisfaction may decline if the service fails to keep pace with such changes. As other commentators have noted, ‘it is generally presumed that, over time, what the public expects in terms of the quality of service – not just from the NHS, but from public services more generally – has been increasing If this is the case, then a fall in satisfaction may be, in part, the result of the NHS failing to keep up with expectations (rather than a fall in the actual quality of services)’ (Kings Fund 2012).  

If focusing on the quality of care received, the results from the BSA survey are interesting in that they appear to contradict the findings from recent surveys of patients at both national and local level. Notwithstanding some very high profile failures (such as those at Mid-Staffordshire and Morecambe Bay) the large majority of patients when asked about their own experiences of the care they received are highly positive. This is borne out by Care Quality Commission reviews, the NHS Patient Surveys 2011-12 (which saw circa 90% of patients rate their experience as either good, very good or excellent) and local patient experience work. Such discrepancies may be the result of a number of factors, and it is impossible to cover all of these here. Suffice to say, however, that one needs to consider the characteristics of those who respond to any survey, the extent to which they have personal / recent experience of using a service and to understand the areas of provision which are of greatest importance. Other factors, such as the influence of media coverage of the NHS  reforms, the changing relationship between patients, professions and the state and wider, very public, staff dissatisfaction with pension reforms and the implications of efficiency gains (often articulated as ‘cuts’) and service reorganisation may also play a part. 

The results should however focus attention on the wider question of public service provision within an increasing competitive environment, and here there may be parallels between macro health policy over the past few years and recent reforms within Higher Education. In the NHS in England, for example, there has been a growth in what might be termed ‘marketisation’, whereby ‘any qualified provider’ is able to offer services, where some patients have control over a personalised (NHS) budget to secure support/care and the emphasis is on enhancing the role and voice of the user in service design, delivery and improvement.  Within such contexts, understanding users and potential users expectations / intentions is critical in terms of business continuity / growth, and it it essential that public sector organisations can demonstrate that they actively involve  users at all levels of decision making and that they provide a service which is of a high quality.
Dr Katherine Birch is Senior Academic Quality Advisor at Liverpool Hope. Prior to moving to Hope in 2012, she was Head of Clinical Audit and, for a short while, also Head of Patient Experience at Liverpool Women's Hopsital. She has previously been Deputy Director of a National Governance Support Unit and has a specific interest in quality, corporate governance and risk management. 

[1] Since 1983 the British Social Attitudes survey has asked a sample of the public about their views and feeling towards the NHS and health care issues generally. 

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