Between dissatisfaction and support: justificatory repertoires in public feedback on emergency healthcare in the United Kingdom National Health Service

Quantitative studies of public opinion on healthcare often distinguish between support for the system and satisfaction with its services. The relationship between these two dimensions can appear contradictory: in UK surveys strong support for the NHS co-exists with rising dissatisfaction with care quality. We investigate this apparent contradiction through a novel analysis of 169 critical reviews of emergency care visits in the UK submitted to the Care Opinion platform between 2015 and 2023. While reviews all describe instances of poor care, we identify the ‘justificatory repertoires’ through which reviewers express continued support for the NHS. We argue this reveals how societal attitudes towards public healthcare provision are in a recursive relationship with actual experiences of healthcare, and that the articulation of those experiences is deeply shaped by awareness of the broader political context. Analysis of patient narratives reveals complex relationships between solidarity and dissatisfaction in public opinion, and insights into policy feedback loops between healthcare provision, institutional design and public attitudes toward healthcare.