Olli Potter, senior policy officer at Picker explains why measures to improve the patient experience of waiting are essential to regaining public satisfaction in the NHS.
As Keir Starmer approaches one year in office, this month marks another milestone for the prime minister – his fifth anniversary as leader of the Labour party. The world today looks very unlike April 2020 and our present is coloured with different, albeit linked, anxieties about health and wellbeing, public services and the economy.
In April 2020, the NHS was only weeks into one of its greatest-ever challenges: tackling Covid-19. The public is well-versed in the challenges of this period, at a personal, community, and national level. The impact of the pandemic on a health service that had already felt the sting of austerity in the 2010s was, and continues to be, immense – both operationally and personally for the NHS staff who worked throughout this global public health crisis. This confluence of complex challenges has resulted in record NHS waiting lists, with more than 6.25 million people waiting for elective care in January 2025.
The public’s view
The latest results from the British Social Attitudes (BSA) survey show that 59% of people said they were “very” or “quite” dissatisfied with the NHS – a seven percentage point increase on 2023 (52%) and the highest recorded level of public dissatisfaction with the health service since the survey began, 41 years earlier, in 1983.
It would seem, then, on this data, the secretary of state for health and social care’s analysis that the NHS is “broken” matches the public mood.
The BSA results also tell us where public concern is greatest – namely, around accident and emergency care, NHS dentistry and primary care services in local communities. There is a commonality in these core concerns – the public is worried about the front door to the NHS. This is reflected in the survey’s top public priorities too: making it easier to get a GP appointment, improving waiting times in A&E, alongside improved waiting times for planned operations and increased staff numbers. The results also show the public is much more concerned about access to care than they are about the quality of services.
Measuring patient and staff experience
Picker is commissioned by the Care Quality Commission (CQC) to deliver the NHS patient survey programme, and by NHS England to deliver the NHS Staff Survey.
While we have to be cautious about making direct comparisons across different surveys, there is an opportunity to triangulate some themes. For example, respondents to the urgent and emergency care (UEC) survey, published in November last year, generally reported poor experiences of UEC, particularly in A&E.
For the first time, survey respondents were also asked why they attended UEC instead of another service, with results showing a lack of timely access to other services potentially contributing to UEC attendance. This shows the impact of access issues on people’s behaviour, just as the BSA survey shows how access drives dissatisfaction.
The BSA results also demonstrate that only one in nine members of the public (11%) agree that there is enough staff in the NHS. The most recent NHS Staff Survey results show, conversely, small improvements in staff perception of workforce capacity. In 2024, 34% of staff said there are enough staff at their organisation for them to do their job properly, up from 32% in 2023, but down from 38% in 2020.
Overall, though, the continuing low levels of agreement demonstrate the capacity pressures felt by NHS staff – and as shown by the BSA results – identified by the public.
Driving person-centred improvements
The new government is less than a year in power and acutely aware of the challenges facing the NHS. It made tackling challenges in the health service and building “an NHS fit for the future” one of its five core missions for government and announced the commission of a 10-year plan for health, expected in June, which provides an opportunity to reset the NHS and reassure the public that change is possible. For staff, the upcoming refresh to the NHS Long Term Workforce Plan offers a similar window of opportunity.
Driven by a desire to deliver person-centred care, the 10-year plan should clearly outline what support will be offered to people who are waiting for care, building on, and expanding, the person-centred commitments outlined as part of the elective reform plan in January. Particularly as research has shown that waiting can disempower patients, and, in the face of uncertainty, risks increased levels of stress, anxiety, and depression.
Without support, there is a risk that patients live with pain and discomfort, worry about their symptoms worsening, or develop secondary conditions. These problems can, in turn, lead to increased need and this can impact on demand for emergency care pathways and GP appointments. The recently published community mental health survey, for example, found that 42% of respondents reported that their mental health deteriorated while they waited for their first appointment.
Interventions to support waiting well, including education for self-management and peer support offers, are tried-and-tested and offer low-cost, person-centred solutions at a time when money is constrained and patients are waiting to access care.
The government must not shy away from the reality that a defining feature of the public experience of the NHS will, in the interim, regrettably, be characterised by waiting. This is because reducing waiting times will take time, particularly when the other key ingredient – money – is in short supply.
Honesty, coupled with a clear plan for change, will help rebuild public satisfaction with the health service in the long term. In the shorter term, a programme for waiting well can reduce anxiety and frustration, empowering people waiting for care.
