Satisfaction with NHS & Social Care: Focus on service users

Posted on 27th March, 2024


This is Blog No 64


Media coverage of the King’s Fund survey of public satisfaction understandably centres around the headline findings and the tale of declining confidence has immense political significance.

But in a well-conducted research project like this, some of the most helpful insights lie buried deep in the full report, and, from my initial reading of the document published today, my immediate reaction is to try to understand the different perspectives of those with real-life user experience of a service.


The truth about many public services – and also of commercial goods and services is that perceptions are formed by a mixture of experiences. Direct and Indirect. For specialists in customer satisfaction, it has always been a challenge to disentangle opinions formed from using a product or service directly from views influenced by media reporting or other reputational inputs. It’s the same issue that I covered when discussing ‘perceptions of risk’ in Blog 61.


In the King’s Fund/NatCen Report, there is a whole section analysing the satisfaction data according to whether or not the respondents had direct contact with the service. It shows, for example that whereas only 26% of the sample without contact with the GP service are ‘satisfied’, this rises to 38% where there had been contact. For dentistry, the figures are even more stark. 13% from those without contact; 46% for those with contact, probably reflecting the difficulty of obtaining the service. Most worrying for policymakers are the findings on social care. User experience (in the sense that ‘contact’ is an indicator) makes no difference to the low satisfaction level (16%) but dramatically worsens the percentage being ‘dissatisfied’. Of those without ‘contact’, 48% describe themselves as dissatisfied. Of those who have had ‘contact’ this rises to an astonishing 68%. This is a clear indictment of the delivered quality of the service. Politicians everywhere should take note !


These issues arise in many aspects of public engagement – and not only in Health and Social care.


For those involved in organising public consultations, here are five lessons worth considering


Headline figures seldom provide the most useful insights

Yes, it is important to see the full picture, and overall satisfaction levels clearly matter in the wider political debate. But they are often misleading. Campaigners opposing various initiatives are often guilty of trumpeting the largest figure of objectors they can find. Years ago, when delivering a training course in Durham, we entered the Town Hall beneath a huge banner proclaiming something like “90% of the people oppose the abolition of this Council” In fact, the data was that 90% was of those who self-selected themselves respond in this way to a smallish survey! Not the same thing at all. Consultors can be equally culpable. Not long ago I saw that “only 2% of the population have said they oppose the pylons.” !!! 


Understand the pattern of User interactions

It is essential to distinguish between real personal experience and derived or second-hand information. The King’s Fund study, whilst excellent in most respects, is not ideal in this respect. Firstly, its concept of ‘contact with the service’ is not quite the same as having been the direct recipient. Secondly, there is insufficient granularity regarding the ‘extent’ of usage. It treats someone who had a single interaction in outpatients in a given year the same as someone who had ten!  As a comparison, consider the controversial consultation in 2023 about the prospective closure of railway ticket offices. (See Blog No 35). A justifiable criticism of the consultation was that it failed to gather any data as to whether or the extent to which the respondent used the railways. Regular commuters’ input was treated the same as someone who hadn’t travelled since the time of Dr Beeching. (for younger readers, please use Wikipedia)


Ensure dialogue with groups that represent users

In Health and Social care – as in other fields, there are representative groups with undoubted legitimacy. They are often key stakeholders and deserve an important role in public engagement and consultations. They are often there by statute – such as Overview Committees or Healthwatch; others are essential because they represent key actors in service provision, like Royal Colleges, trades unions and some of the leading charities. But many of these include seasoned ‘advocates’ – there because of unquestioned sense of civic responsibility and often hugely experienced in the ways of our bureaucracies. But, no matter how hard they try, they cannot always replicate the personal testimony and perceptions of actual patients or actual passengers. Or tenants  … or pupils … or asylum seekers. It is therefore incumbent upon consultors to identify cohorts of users, establish dialogues with them – not instead of the existing stakeholder relationships – but in addition!


It’s not what they think … it is why they think.

Surveys like this are good at probing the causes of dissatisfaction, though not much of the detail has yet been published. It offers respondents a set of prepared sentences and gives them the opportunity to select three with which they agree. For example “The top reason for dissatisfaction with social care was that people don’t get all the social care they need (64 per cent) followed by the pay, working conditions and training for social care workers not being adequate (57 per cent) and there not being enough support for unpaid carers (49 per cent).”  (at Page 28 of the Report)

Data like this is fine, but we need to go deeper, and the best way to do this is to gather together a range of people in a Focus Group or equivalent. Find out what made them choose a particular option, and allow different views to be heard and debated under the direction of a trained facilitator.


The data changes


For all the attention this Report will gather, I wonder how many people will notice that the data was collected in Autumn 2022. We were still batttling with the backwash of the pandemic. Ukraine was only invaded six months earlier. Energy prices were about to treble and the protracted clinicians’ strikes had hardly started. The world has since changed, and these figures do not necessarily report what the world thinks now. Similar problems of timescales affect public consultations – with long delays in legislation often leading to a disconnect between what stakeholders may have said some time ago, and what they might say now. Last year, the High Court ruled that the Government could not rely, for its proposed changes to employment legislation on a consultation undertaken seven years earlier. It's the ASLEF case. (See Blog No 34). With long-winded processes such as those for Development Consent Orders for large infrastructure projects, this is a recognised pitfall. Public attitudes change.



For anyone working in Health and Social Care public engagement, this Report should be compulsory reading. But for others – working in other sectors, or in policy-making generally, there are important lessons to learn and issues to consider.


Rhion H Jones LL.B


See Rhion's Speeches etc - click here


For More like this - free of charge:   now click here



Leave a Comment

I hope you enjoyed this post. If you would like to, please leave a comment below.

There are currently no comments to display. Add Comment.