Overall satisfaction with the NHS fell to 29% in 2022, a 7% drop on 2021, according to a survey published Wednesday from British Social Attitudes. For the last four decades the BSA has asked a group of about 3,000 people annually what it’s like to live in Britain. The UK public expressed the lowest level of satisfaction with the NHS last year since the BSA survey began.

The NHS has been struggling to keep up with demand for years amid an aging population. Problems were exacerbated by the Covid—19 pandemic, which increased the backlog of cases for surgeries and routine appointments, as well as the number of people receiving a late diagnosis.

The system has also been dealing with strikes across the industry from nurses to paramedics, as staff demanded more pay from the government. Several health unions recently put a new pay offer to their members.

“This should send shockwaves through the heart of Westminster and yet the findings will come as no surprise to those working across health and care,” said Patricia Marquis, Royal College of Nursing director for England, in a statement.

More than two-thirds of those surveyed said waiting times for doctor and hospital appointments were drivers of their dissatisfaction with the NHS. A record 40% of people said they were unhappy with accident and emergency services.

Still, the majority of the British public believe the NHS should be free of charge and available to everyone, with the majority of its funding coming through taxation, according to the survey.