Scottish Social Attitudes Survey 2011: Core Module - Attitudes to Government, the Economy and Public Services in Scotland

4 Changing Views: Standards in Public Services in Scotland

Introduction

4.1 This chapter summarises:

• Views on standards in the health service, education and public transport in Scotland in the past twelve months
• How views on the health service, education and public transport have changed over time
• How views on the performance of the health service compare with levels of satisfaction with the health service.

4.2 As discussed in Chapter One, the Scottish Government's national indicators include a commitment to improving perceptions of the quality of public services. The main data for this indicator is provided by questions in the Scottish Household Survey which ask people how satisfied they are overall with health services, public transport and schools. SSA takes a somewhat different approach to examining perceptions of public services. Rather than asking how satisfied people are, it asks whether they think that standards in key services (health, education and public transport) are falling, increasing or have stayed the same in the last year. Understanding perceptions of changing standards can help policy makers assess whether or not recent attempts to improve services (as well as any challenges they may have faced) are reflected in public opinion.

4.3 As discussed in previous chapters, the 2011 SSA survey took place in a context of intense debate about the impact of budget cuts on public services. Overall the Scottish budget in 2011 reduced by 5% in real terms (after adjusting for expected inflation of 1.9%). The health service budget was protected in 2011, but still reduced in real terms by 1.1%. In comparison, the education budget reduced by 10.3% in real terms. Furthermore, although certain parts of the transport budget increased (e.g. spending on motorways and trunk roads, and ferry services), overall the transport budget also decreased considerably.

4.4 However, in spite of these budget reductions, only a minority of between around 1 in 5 to 3 in 10 felt that standards in the health service, education and public transport in Scotland had fallen in the 12 months prior to the 2011 survey. The most common response in 2011 in relation to all three services was that standards had stayed the same (Figure 4.1 - 39% for each of health and public transport and 30% for education). Around 1 in 5 in each case felt that standards were increasing (22% for health, 20% for education and 17% for transport).

Figure 4.1: Perceptions of public service performance over the last 12 months^[27]

Base: All respondents.
Sample size: 1,197

4.5 More people felt that standards in the health service had fallen (31%) than said the same of standards in education (26%) or transport (21%).People were also more likely to have an opinion about standards in the NHS than about education and public transport. Around a quarter in each case (24% and 23%) felt they did not know whether standards in education or transport had increased, compared with around 1 in 10 for health (9%).

Perceptions of changing standards over time

4.6 Reviewing trends in standards in public services over the last five years shows that:

• The proportion that felt standards in the NHS had fallen in the past 12 months reduced marginally from 34% in 2010 to 31% in 2011.^[28] The 2011 figure was still significantly higher than that for 2009 (25%), however.
• A slightly different pattern is apparent in relation to education, with a steady rise since 2007 in the proportion thinking that standards in education have fallen from 12% to 26% in 2011.
• At the same time, the proportion saying standards in education have stayed the same has reduced by 15 percentage points since 2007, from 45% to 30%.
• For public transport there has been a steady decline in the proportion saying standards have increased. In 2007, 27% thought that standards in transport had increased, but this had reduced by ten percentage points to 17% by 2011.
• The proportions of people saying standards in public transport have stayed the same or fallen were similar in 2007 and 2011 (38%/39% and 18%/21%).

Table 4.1: Recent trends in perceptions of standards in public services in Scotland

Satisfaction with the health service

4.7 As discussed above, perceptions of changing standards in the NHS in 2010 and 2011 were somewhat more negative than they had been in 2007 and 2009. The questions reported above ask about perceptions of change, however, and not about overall satisfaction with a particular service at a particular point in time. Views on these two issues may differ. For example, people may think that service standards have stayed the same but still be satisfied with the standard provided. Equally, people may feel standards are improving, but still consider them to be unsatisfactory overall.

4.8 In 2011, SSA also included a question on overall satisfaction with the way the NHS runs nowadays.^[29] In 2011, 56% of people in Scotland were 'very' or 'quite satisfied' with the way the NHS runs. This is considerably higher than the 22% who felt that standards in the NHS had improved in the 12 months prior to the 2011 survey. Thus some of those who do not feel that standards are improving must nonetheless be satisfied with the NHS in Scotland overall.

4.9 This is confirmed by Table 4.2. Unsurprisingly, over four-fifths (83%) of people who said that standards in the NHS had increased were also either 'very' or 'quite satisfied' with how the NHS runs nowadays. But satisfaction levels were also high among those who thought standards had stayed the same - around two thirds (64%) were 'very' or 'quite satisfied'. And even among those who thought that standards had fallen in the last 12 months, over a quarter (27%) were 'very' or 'quite satisfied'. So although people were far less likely to be satisfied with the NHS if they thought standards had fallen, the majority of those who thought standards had either stayed the same or increased were satisfied with how the NHS runs nowadays. This explains why, although only 22% of people think that standards in the health service have increased in the last year, over half (56%) are satisfied with the NHS, as this group also includes the majority of those who think that standards have stayed the same in the past 12 months (as well as most of those who think that standards have increased and even some of those who think standards have fallen).

Table 4.2: Satisfaction with NHS by changes in NHS standards (2011)

Base= All except those who said 'don't know' to changes in NHS standards question.

4.10 In terms of trends over time, satisfaction with the NHS in Scotland fell between 1999 and 2005, but has steadily been increasing since (Figure 4.2). In 2005, 40% of people were either 'very satisfied' or 'quite satisfied' with the way the NHS runs nowadays compared with 56% in 2011. A similar upward trend has been apparent in satisfaction with the NHS in Britain as a whole.^[30] From the mid-2000s up to 2011, overall satisfaction with the NHS in Scotland thus appears to have been improving. Yet over the same period, perceptions of whether or not standards in the NHS are improving or falling have been more changeable, with recent years seeing an increase in the proportion who said standards were falling (rising 26% to 31% between 2007 and 2011). While the reasons for this difference in levels of satisfaction vis a vis perceptions of recent NHS performance are not clear, they may, perhaps, suggest that people are basing their responses to these two questions on rather different considerations. For example, perhaps people are more likely to draw on personal experience of specific services in assessing their overall satisfaction, while perceptions of standards may be more influenced by other factors, like media coverage around budget cuts to particular areas of the NHS, waiting times, particular cases where patients have had negative experiences of treatment, etc.

Figure 4.2: Proportion 'very satisfied' or 'quite satisfied' with the health service (1999 - 2011)

Sample size: See Annex B, Table 2