Spare change: the public and NHS funding

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Is the NHS adequately funded, and how should funding be raised? Harry Evans explores the findings of the British Social Attitudes survey on public attitudes towards NHS funding and taxation.

In 2018, NatCen’s British Social Attitudes survey asked adults in Britain (not just England) about their attitudes towards funding and quality of care in the NHS, in questions sponsored by The King’s Fund. Fieldwork was conducted between July and October 2018.1

A lot happened while NatCen was surveying the public. As fieldwork started we had the NHS’s 70th birthday and the announcement of £20.5 billion extra for the NHS by 2023/24. Just after BSA fieldwork closed, the Chancellor announced this would be funded through higher than expected tax receipts, not increased borrowing or taxes.

The BSA findings in 2017 showed that there was concern about NHS funding and support for increasing taxes if the NHS needs it, along with a growing pessimism for the future. So, with the promise of increased funding, did public views change?

Has concern about NHS funding fallen?

The survey findings seem to suggest that the announcement of extra funding hasn’t had much impact. Concern about funding is still historically high – in 2018, 83 per cent of survey respondents felt that there was a major or severe funding problem in the NHS, compared with 72 per cent back in 2014. The change in concern since 2017 was not statistically significant.

Base: approx. 1,000 British adults, aged 18+ / Source: The King’s Fund analysis of NatCen’s British Social Attitudes survey data

Have attitudes towards NHS taxes changed?

The public’s willingness to pay more in tax to fund the NHS has also remained steady. We asked respondents which of a range of revenue-raising options they would be willing to accept if the NHS needed more money. In 2018, the majority (58 percent) said they would be willing to accept an increase in taxes, and the change from the previous year was not statistically significant.

Tax increases to fund the NHS still enjoy majority support from both Conservative (58 per cent) and Labour supporters (63 per cent). For both groups, changes in the level of support from the previous year were not statistically significant.

Other financial measures, such as paying more for non-medical costs, paying to visit a GP or accident and emergency (A&E), and ending exceptions from current charges, did not see statistically significant changes. Similarly, the numbers who said they did not want to see any increases in taxes or charges – ‘the NHS needs to live within its budget’ – stayed the same.

Q. If the NHS needed more money, which of the following do you think you would be prepared to accept?

 2014(%)2015(%)2016(%)2017(%)2018(%)
Pay more through the taxes I currently pay1717212624
Pay more through a separate tax that would go directly to the NHS2424283534
Pay for non-medical costs in the hospital, like food and laundry12121187
Pay £10 for each visit to a GP or local A&E department1415141112
Ending exceptions from current charges33523
None of the above; the NHS needs to live within its budget2726201517
Don't know32123
      
% pay more taxes (combined)4142496158
% increase costs to service users (combined)2930302122

Base: approx. 1,000 British adults, aged 18+ / Source: The King’s Fund analysis of NatCen’s British Social Attitudes survey data

After years of austerity, there are many claims for public spending increases – not least from social care, public health and NHS training budgets. The decision not to raise taxes to pay for NHS funding will leave the Chancellor with some difficult choices in the Spending Review.

What are the public’s views about alternative funding measures?

Over the past 20 years, a question has been asked on and off about whether the NHS should only be available to those with lower incomes. The proportion who oppose this ‘means-testing’ has remained fairly consistent. In 2018, 75 per cent opposed means testing, the same proportion as the first time the question was asked in 1995.

The NHS being available to all, whatever their income, is a core principle of the NHS and we know from our other work that the founding principles of the NHS remain overwhelmingly popular. The stability of opposition to means-testing reinforces the evidence that people hold dear the fundamental principles that the NHS was founded on.

Base: approx. 1,000 British adults, aged 18+ / Source: The King’s Fund analysis of NatCen’s British Social Attitudes survey data

Are people more positive or more optimistic?

Between 2017 and 2018, the proportion of respondents who felt that the standard of care in the NHS had declined over the past 5 years fell from 45 per cent to 39 per cent, which is around the same proportion who felt the standard of care had stayed the same. The proportion who felt care had improved was 20 per cent in 2018 and the change from the previous year was not statistically significant.

Base: approx. 1,000 British adults, aged 18+ / Source: The King’s Fund analysis of NatCen’s British Social Attitudes survey data

Despite some positivity about changes in the quality of care over the past five years, optimism for the future remains low. In 2018, only a quarter of people thought that the standard of NHS care will get better over the next five years, and 51 per cent thought NHS care will get worse. For both measures, changes from the previous year were not statistically significant.

Base: approx. 1,000 British adults, aged 18+ / Source: The King’s Fund analysis of NatCen’s British Social Attitudes survey data

In contrast to these findings about views on the quality of NHS care, our recent report with the Nuffield Trust showed that public satisfaction with the NHS in 2018 had declined for a second year in a row, and satisfaction with general practice remained at an all-time low (NatCen’s BSA survey has data going back to 1983). This data suggests falling overall satisfaction may have been affected by factors other than standards of care, public perceptions of which have remained steady or improved.

Finally, concern about funding pressure on the NHS remains high and the funding announcement in 2018 did not impact this. As with overall satisfaction,the public will need to see more than just warm words and positive media stories before they are willing to recognise funding pressures are coming to an end.

  • 1.The survey asked 973 adults in Britain (not just England) about their attitudes towards funding and quality of care in the NHS. Further details of the methodology can be found in our report on the BSA public satisfaction findings.

 

Comments

John Carlisle

Position
Researcher,
Comment date
09 May 2019

Why did the questionnaire ask about funding from taxation when it is becoming increasingly accepted that public service funding is actually paid by the Central Bank as loan (MMT)? Is it because you wanted a gauge to measure the level of sacrifice, which is an acceptable deception, or because you think funding from taxation is true?

Harry Evans

Position
Researcher,
Organisation
The King's Fund
Comment date
09 May 2019

Thanks for your comment John. As you say, these questions ask about willingness to pay more in taxes either through central taxation or, alternatively, through a ringfenced tax. The question, as phrased, is helpful in understanding the difference between these two hypothetical scenarios (thus not a deception at all). This is both a topical question, and most likely the one that it makes most sense to pose to people given conventional understanding of how the NHS is funded. It also helps us understand whether the public would prefer central funding versus increasing costs to users of health services. Again, this is relevant to current discussions of how people believe the NHS should be funded.

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