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What do British people think about the state of the health service?

Posted on 09 February 2015 by NatCen, Research .
Tags: ESS, Europe, NHS, health

This is the second in a series of blogs using the European Social Survey (ESS), a high quality survey across a number of European countries, to look at how the UK compares with the continent on some of the big issues coming up in the May General Election.

In recent weeks the newspapers have been awash with headlines about the A&E crisis, excess winter mortality and our own British Social Attitudes findings on rising satisfaction.  We know that the NHS is one of the key deciders for voters across the political spectrum.

So what do British people think about the state of the health service in the UK and how has this changed over time?

Since 2002, ESS has been asking people around Europe their thoughts on the state of health services in their country, making it possible to compare how we match up compared to our European neighbours.

A third of the UK public think the health service is in a very good state

In 2012, 33% of the public thought the health service was in a very good state – rating it 8, 9 or 10 out of 10. This is more than double the amount who thought the same thing when the survey began in 2002.

Proportion of UK public rating health service 8 or above out of 10

 UK Trend

Question: please say what you think overall about the state of health services in [country] nowadays? Rating out of 10 where 0 is extremely bad, 10 is extremely good.

How does this compare with the rest of Europe?

In 2012, UK views rated the health service in the top third of countries surveyed, where it has been since 2008.

Proportion of people rating health service 8 out of 10 or above in 2012

 EU 2012

As we have come to expect on a range of these kinds of measures, Scandinavian countries tend to score highest, with the lowest ratings among countries in Eastern Europe: Russia, Bulgaria, and Ukraine. It’s possible these differences in satisfaction could be down to cultural biases – people in northern Europe are well-known to have a positive outlook, whereas the same can’t be said for those further east.

How does the public view of the state of health services compare to the quality of a health service?

It’s interesting, however, to consider whether public views of a health service are a good reflection of the actual quality of healthcare being provided or whether the kind of health system makes a difference.

Consistently perceived to be in the worst state was Ukraine’s health system. This is perhaps unsurprising, given that the free universal state provision that should be available in theory is rarely available in practice – although it should be noted that in recent years the Ukrainian government has been discussing plans to roll out healthcare reforms including compulsory public health insurance from 2016.

Belgium, on the other hand, has been one of the top three countries since ESS began in 2002. The Belgian system comprises of a mixture of state and non-profit hospitals, and private dentists and GPs. Unlike in the UK, healthcare is not free at the point of use; patients must pay and will be reimbursed some of the cost at a later date.

One possible proxy for the quality of a health service is the number of medical staff per head of population. 

Looking at Belgium, as assessed by the World Health Organisation, we can see that the quantity of medical staff (188 doctors, nurses and midwives per 10,000 population compared to the European average of 113 and Britain’s 116) means that waiting times are short.

Proportion of people rating health service 8 out of 10 or above in 2012 and medical staff per head, by European country (WHO data)

 2012 Scatter Health

In fact, the graph above demonstrates that there is quite a good correlation between the number of doctors, nurses and midwives and the perceived state of the healthcare system across Europe. For example, well-performing countries such as Finland, Denmark and Switzerland have numbers of medical staff far above the regional average of 113 (137, 195 and a whopping 213, respectively). Conversely, Ukraine counts 111 medical staff per 10,000 people and Bulgaria has just 85. However, there are some outliers like Israel and Iceland.

Interestingly, the number of medical staff per head in the UK is considerably lower (116 per 10,000 population) than most of the other countries with similarly highly rated health services – like France, Norway, Sweden and Germany (125, 171, 143 and 153 respectively). It seems that, in terms of delivering a service that keeps the public happy with fewer staff, the UK is punching above its weight.


 The ESS is a cross-national survey that has been conducted every two years since 2002. It provides methodologically rigorous, comparative data about public attitudes and behaviour over time in more than 30 countries. It has its headquarters at City University London.

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