Healthcare headlines this week covered the latest release of the annual British Social Attitudes survey. This year’s findings present  a critical point in the public’s relationship with the NHS. Just 21% of people surveyed are satisfied with how the NHS is run – the lowest level since the survey began in 1983. Nearly 60% are now actively dissatisfied, up from 52% in 2023. Rather than a seasonal dip driven by winter pressures or a short-term backlash over isolated scandals, the sharp statistical change  is a warning signal for  the Government, which has made “fixing the NHS” a cornerstone of its offer to voters.

While concern about waiting times continues to dominate headlines, the survey data suggests that dissatisfaction now extends beyond the issue of delays. Fewer than one in seven believe the NHS spends its money efficiently, and fewer still think staffing levels are adequate. The system is not just seen as overstretched but poorly run and failing to deliver value. Social care fares even worse, with just 13% of people expressing satisfaction and a majority unhappy with service availability and quality. This reflects widely voiced concerns from across the sector, as social care services prepare to tackle unsupported cost increases in the face of new changes to National Minium Wage and employer National Insurance contributions.

The figures in this year’s Social Attitudes survey are the baseline from which the Government’s confidence-building mission during this parliamentary term will be judged. Clearly, turning these numbers around will be no small task and the sheer depth of public concern means that quick fixes or modest reforms will no longer suffice.

Visible decline

Meanwhile, the lived reality for many patients and staff is one of limited access, decaying infrastructure, and unsafe environments. In the healthcare news this week, we also saw new polling published by the BMJ, in which over half (54%) of UK adults say they or someone close to them has struggled to access NHS care in the past year, with 13% saying they or a loved one were harmed due to delays – a striking indictment of the system’s capacity to meet need.

At the same time, 17% of staff said they did not believe their NHS building was safe in a new Unison survey which revealed evidence of widespread pest infestations; collapsed ceilings; broken toilets and sewage leaks. These are not marginal issues – they are visible, tangible signs of systemic neglect that simply reinforce public perceptions of a service in freefall. When the care environment itself becomes a symbol of decline, when patients are dodging buckets catching leaks or reading about rats in sterile storage rooms, the narrative of a crumbling NHS is no longer metaphorical, and confidence doesn’t just erode – it disappears.

The situation is further complicated by industrial tensions. The BMA has warned that unless the government accelerates the pay review process for hospital doctors, strikes will resume – a move likely to worsen the care backlog and harden public perceptions of crisis and chaos.

Recent announcements of the scrapping of NHS England and reorganisation of ICBs will do little to restore public faith in the short-term and may even work to jeopardise it further as governance and structure take political priority over impactful, systemic reform. In the current climate, it will be hard to convince a public already fatigued by years of organisational change that these decisions are being made for the long-term benefit of the NHS, as the Government intends.

Where does the NHS go from here?

What’s emerging is a complex picture: voters still support the core principles of the NHS – publicly funded, free at the point of use – but they no longer believe the system is capable of delivering on them. This is a politically dangerous disconnect, and the Government’s ambitions to restore confidence in the NHS must walk a fine line of offering short-term improvements without sacrificing the long-term reforms needed to ensure sustainability. They need to work efficiently to begin fixing the system at its roots, whilst tackling increasingly visible signs of deterioration and perceived waste of public money.

The road to repair is long, but the cost of inaction is clear – further decline, deeper disillusionment, and the erosion of Britain’s most fundamental public institution.