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WASHINGTON, D.C. -- After years of decline, Britons’ satisfaction levels with vital public services such as healthcare and public transportation in 2022 dropped to their lowest points in more than a decade.

These trends could be a troubling sign for a government that has suffered substantial losses in recent local elections and that faces a general election in 2024. Further, widespread labor strikes in recent months do not bode well for improved public perceptions of these services in 2023.

Sick Man of Europe: Britons’ Satisfaction With Healthcare Hits Record Low

The United Kingdom’s National Health Service (NHS), which guarantees free, universal healthcare coverage to all residents, has typically been a point of pride for the British. However, Britons’ satisfaction with the availability of quality healthcare in their area hit a new low point of 67% in 2022, after falling steadily from a peak of 92% in 2011.

Over the same period between 2011 and 2022, globally, only Venezuela saw a larger drop (34 percentage points) in healthcare satisfaction than the U.K. (which dropped 25 points). Venezuela has experienced economic collapse and a series of other crises that have severely strained its healthcare systems in recent years.

In 2011, the U.K. ranked among the most satisfied countries in the OECD, tying Luxembourg (93%), Austria (92%), Germany (91%) and Belgium (90%) for the top spot. Now it finds itself in 21^st place and in the bottom half of 38 OECD countries. Britons are now less satisfied with the availability of quality healthcare than residents in allied countries such as Germany (85%), France (71%) and the U.S. (75%) -- none of which have government-funded health systems like the U.K.

A hugely important part of British national life, the NHS is a key topic during elections. Worryingly for the conservative government, there is no difference in satisfaction with the availability of quality healthcare among those who approve (68%) and disapprove (66%) of the U.K.’s political leadership. This negates a trend for much of the past decade, in which those who have approved of the U.K.’s leadership have been more likely to be satisfied with the availability of quality care.

Work stoppages are another point of concern for the incumbent party. In February 2023, nurses and ambulance workers staged the biggest strike in NHS history. Plans by England’s largest nursing union for additional large-scale strikes could further jeopardize Prime Minister Rishi Sunak’s promise to bring down waiting lists for healthcare services.

Public Transport Stuck in Reverse

Britons’ satisfaction with public transportation also hit its lowest point in more than a decade in 2022, at just under two-thirds (64%). The first five years of the David Cameron government were a relative success in transport policy from the public’s point of view: Satisfaction rose from 66% in 2010 to 76% in 2015, before beginning a gradual seven-year decline.

Much like in satisfaction with healthcare, the U.K. has fallen in the OECD rankings for public transport. At its peak (76%) in 2015, the U.K. ranked among the top five most satisfied in the OECD with their public transportation systems. In 2022, the U.K. did not make the top 10.

Britons’ satisfaction with their public transport systems may well continue to reverse in 2023. Following Gallup’s 2022 World Poll in the U.K., many rail operators on busy commuter lines came under intense criticism in the national media for poor service. Mass industrial action has also resulted in dramatically reduced rail service on numerous days in recent months.

Bottom Line

With a general election on the horizon toward the end of 2024, the state of Britain’s public services after years of budget cuts under austerity will be a key issue for the main parties. Declining satisfaction with healthcare and public transportation in recent years has occurred against a backdrop of rising economic pessimism in the U.K.

Economic issues like high inflation have also fueled the labor strife that has disrupted these services and others, including the country’s schools. The U.K.’s national statistics agency reported in February that the country lost more working days to industrial action in 2022 than any other year since 1989. With further strikes planned across the public sector, it is likely that satisfaction with vital public services will fall further in 2023.

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