Conclusions 

We have used the 30th anniversary of British Social Attitudes as an opportunity to focus on changing attitudes over the last three decades in two key areas: satisfaction with the NHS and views about government priorities for taxation and spending. Here we give some thought to what these tell us about the way in which the public might react to the most recent set of funding and policy changes by the coalition government. Fluctuations in public satisfaction with the NHS over the last 30 years appear to be related at least in part to NHS performance, policy and spending. Satisfaction was highest in 2010 after a period of intensive injection of additional funds, and lowest in 1997 at the cusp of the Conservative and Labour governments. The last two years (under the coalition government) have seen a substantial drop in public satisfaction with the NHS, and there is no suggestion of a quick recovery. This may be because there are continuing concerns about the government's organisational reforms of the English NHS (Appleby, 2013). The Health and Social Care Act was passed in 2012 and local clinical commissioning groups only assumed responsibility in April 2013. It may take a few years to see what the impact of these reforms in practice has on public satisfaction. The change over the last three decades in the proportion of the population of pensionable age and its impact on health care is one of the stated driving forces for the NHS reforms (HM Government, 2011). It is therefore interesting to see that, while older people continue to rate the NHS more highly than their younger counterparts, this step-change happens later in 2012 than it did in 1983. 

While the public remains firmly committed to the founding principle of the NHS as a redistributive free-at-source health care system, support for increased spending is currently lower than at other points in the last 30 years. We are now in the midst of a spending freeze that is likely to last beyond the end of the 2010 spending review period (2010/11 to 2014/15) and into the next parliament. Historically, support for increasing taxation and spending on health and other public services generally falls when spending is rising and rises when spending is falling. If the past is any guide we might expect support for higher taxation and spending to increase as spending remains flat in real terms for the NHS (with real cuts in many other areas of government spending). On the other hand, views about taxation and spending will be influenced by the public's attitudes towards the reasons for and origins of the current economic stagnation and debt situation, and their view about the government's policies in regard to these problems. Although the NHS remains the public's top priority for any extra government spending, the proportion supporting health as a priority has fallen over the last decade. Taxing more to spend more on health and other public services may not be seen as reflecting the right priorities given the nature of the economic problems the country faces.

As well as having a broad association with spending on the NHS, attitudes to taxation are associated (in fact, more strongly) with satisfaction with the NHS. We have seen that over the last three decades, when satisfaction decreases, people appear to feel there is more need to increase taxation and spend. However, the dramatic drop in satisfaction levels in the last two years has only been met by a small rise in the proportion supporting increased taxation and spending (by three percentage points), suggesting that spending more to improve satisfaction may no longer be viewed as the solution. This may reflect the particularities of the current general economic situation and a recent period which has seen large increases in NHS funding. On the other hand, it may suggest that the public does not see the level of funding as the key problem with the NHS - at least, not yet.