Less than a third of people in England are satisfied with their public health system, a survey has found.

Just 28% of respondents think the National Health Service is providing a good service nationally — a drop of 6% since November. And more than half (52%) think its performance will get worse over the next year, results from the Health Foundation survey show.

The country’s long-overstretched NHS is struggling to meet demand from an ageing and increasingly sick population. Backlogs for surgical procedures are high and waits for care are long — a situation borne of underfunding and short-staffing, but exacerbated by the pandemic and ongoing industrial action.

Concerns over primary care are rising, with more than three-quarters of survey respondents worried about pressures facing family doctors, who recently announced they would engage in ‘collective action’ over a national contract.

This doesn’t mean all-out strikes. But it means smaller actions that still have a meaningful effect on the health service. For example, family doctor clinics might limit the number of patients they see in a day to 25 — already a high volume, but far below the number most see in practice, according to think tank the Nuffield Trust.

Poor performance in any part of the health service is a serious concern for the public. Most people use the NHS for the bulk — if not all — of their health needs. Most of its services are free at the point of use, with no requirement for insurance.

The Health Foundation’s results track with those of other recent surveys. In March, an analysis of the British Social Attitudes survey revealed historically low public satisfaction with the health service.

The full results of this latest survey of 2,136 U.K. adults will be published on Monday.

“Public satisfaction with the NHS was at a record low prior to the election and the new government will have its work cut out to turn that around,” said Health Foundation assistant director of policy Tim Gardner. “The public want to see steps taken to retain NHS staff, improve GP access and recruit more people to work in the health service.”

Striking doctors are currently considering a pay deal tabled quickly by the country’s new Labour government — a move Gardner praised.

But “the challenges facing the NHS are considerable. There are no quick fixes” he added. “But the NHS can recover with the right mix of policy change, innovation and investment.’”

Saffron Cordery, deputy chief executive officer at hospital industry group NHS Providers, called the survey results “deeply concerning.”

“NHS trust leaders are committed to restoring services and delivering high quality care,” she said in a statement. “Due to the hard work of frontline teams, every effort is being made to tackle waiting lists and ensure people get the care they need as quickly as possible.”

But hospital leaders “know they still have a long way to go,” she added.

NHS Confederation acute network lead Rory Deighton stressed it was important to remember “that thousands of people receive great quality care from the NHS every day, and that staff keep on delivering high quality care in the most challenging of circumstances.”

Nonetheless, “the NHS needs the right investment,” to address its performance problems. “This includes longer funding settlements so leaders can plan for the future, and a step away from short-term thinking,” he added in a statement.

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