How should we pay for health care in future?

Results of deliberative events with the public
Comments: 4
Amy Galea, Anna Dixon, Anastasia Knox, Dan Wellings
To contribute to an informed public debate about both the level of future spending on health and social care, and how that spending might be funded, The King’s Fund, in collaboration with Ipsos MORI, held two deliberative events (one in London and one in Leeds) with members of the general public.

Participants were asked for their views on the NHS, the challenges it faces and how it is funded. They were then given information on the funding challenges and offered possible solutions paying for some services, means-testing or reducing the standard of care. This paper outlines and analyses the responses.

Key findings

  • Participants strongly supported the founding principles of the NHS – that access is based on need rather than the ability to pay, that it is available to all, and of high quality – and wished these to endure.
  • Participants understood how the NHS is currently funded, but welcomed more information about how the money is spent. 
  • If user charges were to be introduced, there was support for applying them to ‘not clinically necessary’ procedures and for needs resulting from inappropriate lifestyle choices or misuse of the system.
  • Means-testing was unpopular both in principle and for practical reasons. However, there was some support for the very rich paying for some services and for voluntary insurance. 
  • Reduction in the quality of care was seen as unacceptable, and paying to secure preferential treatment was strongly resisted, but there was support for optional payment to enhance non-clinical aspects of care (eg, ‘hotel’ facilities).
  • Overall, many understood that the NHS is under pressure, but few accepted that this is on a scale to justify changing the fundamental principles on which the NHS is based.

Policy implications

  • People want to be involved in decision-making about NHS funding; proposals for future change will need to be accompanied by detailed explanation and a public debate.
  • People's attachment to the founding principles of the NHS and reluctance to amend the current funding model suggest that an incremental approach to change is likely to be more acceptable to the public.
How should we pay for health care in future front cover

Print copy: £5.00 | Buy

No. of pages: 36

ISBN: 978 1 909029 07 1


#40352 Pamela Almaz
Bereaved relative
human rights activist

This is the right course. Can't understand why users of the NHS, as well as families, have been excluded until now. Will Govt and parasitic managers take notice or plough on with dismantling what's left of NHS and putting lives at risk. 1200 deaths at MidStaffs is only tip of the iceberg. A corner of Midstaffs in every hospital.

#40353 Jane395

"People's attachment to the founding principles of the NHS and reluctance to amend the current funding model suggest that an incremental approach to change is likely to be more acceptable to the public."

What these results SHOULD suggest is that the founding principles remain fixed and immutable, and discussions revolve around ways to ensure these principles are adhered to.

I listened to Anna Dixon's introduction to the slides for the discussions. They were intended to push people to think that funding needs to expand beyond collective funding through taxation to individual funding based on wealth, nature of the medical care, or the level of quality of the care. These suggestions were firmly rejected and rightly so.

Hopefully the next government, if it is not Tory/LibDem, will put a stop to some of the worst aspects of the recently enacted Health and Social Care Act, which are the fragmentation of care and introduction of wasteful bureaucracy. That would be the first place to start in saving money for the NHS.


Have not had the right help at all via our NHS dispite working in it for many years too. Have had to sell our home and pay to fly abroard for help and lost over 100 grand working hard all my life . Its a disgrace

#40427 Louis Arnold
Outdoor education
youth service

Perhaps if the conservative's had,nt underinvested in the NHS during the Thatcher and Major years and let NHS keep surplus's in the budget rather than taking it back , the hospitals would be upto date at this time !

That is why when Labour took office funding had to rise substancialy in order to improve the state of buildings ect which i would say was one of the major drains at the preasent time , once the infrastructure is upto date we would be able to see say a 20% reduction in the overall cost of running the services while still having money left for future investment .

we need to have a strategy to build new hospitals , say one every 5 yrs until all are brought upto date .

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