Introduction

Since British Social Attitudes began in 1983, the National Health Service (NHS) has undergone great periods of change. There have been three switches in government power (from Conservative (to 1997), to Labour (1997 to 2010), to the current coalition government), each time resulting in a shift of philosophy about how the NHS should be run. Spending on the NHS has more than trebled in real terms in the past 30 years, from around £39 billion in 1983 to nearly £120 billion in 2012. Increased spending has far outstripped the growth of the British population and the demands entailed by an ageing society. It has facilitated an increase in the number of doctors, and advances in medical technology and new drugs. Alongside increased financial investment in the NHS, the last 30 years have seen a number of policy changes affecting the structure and management of the NHS. A number of the resultant changes have been very visible to the British public, such as a dramatic decline in NHS waiting times and a decrease in the number of hospital beds. 

The 30th anniversary of British Social Attitudes provides an opportunity to examine how the British public's views and attitudes towards the NHS have evolved in the last 30 years. British Social Attitudes has measured public satisfaction with the NHS virtually every year since 1983. Each year, we have also asked the public about government priorities for taxation and spending, including the relative priority it places on health care. Focusing particularly on age and party political identification, we seek to understand how and why the public's attitudes towards the NHS have changed over the last 30 years. We report on public levels of satisfaction with the NHS over the past 30 years, and discuss whether, and if so how, satisfaction with the NHS appears to be aligned with government health care policies and government spending on the NHS. We look at the extent to which people's views on the NHS reflect whether they support the political party in power, as well as whether changes in levels of public satisfaction with the NHS reflect the fact that Britain is an ageing society. We assess whether, over the past 30 years, the British public has continued to support the founding principle of the NHS as a health care system which is funded collectively on the basis of ability to pay through taxation, but accessible to all on the basis of need and regardless of income. And we attempt to answer how far the British public has supported government policies around spending on the NHS, and where has there been a divergence of views. Finally, we think through the implications of these issues for the future of the NHS.