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NHS sustainability and the public: a little more conversation


  • Harry Evans photo

    Harry Evan

The House of Lords Select Committee’s report on the long-term sustainability of the NHS strongly endorsed the current NHS model of tax-funded, free-at-the-point of use health care. The report is clear that funding for health and social care will need to increase and that this will require changes to government spending priorities or tax increases.

Beyond 2020, it argues that spending should increase by at least the rate of GDP growth, with decisions based on the advice of an Office for Health and Care Sustainability modelled on the Office for Budget Responsibility.

The report calls for a ‘lasting political consensus’ on the future of the health and care system initiated by cross-party talks and a ‘robust national conversation’. By implication, this means asking people how much they are prepared to pay and where this money should come from. So what do we know about how the public might approach such a conversation?

Since 2014, NatCen’s British Social Attitudes (BSA) survey has asked members of the public about NHS funding and what should be prioritised. The latest data (based on fieldwork conducted in summer 2016) shows a decisive majority (82 per cent) feel there is a major or severe funding problem in the NHS. Not only that, but the proportion of people who feel there is a funding problem is growing, with an increase of 10 percentage points over the past two years. This paints a picture of people becoming increasingly concerned about NHS financial pressures beneath the headline stability we see in public satisfaction with the NHS.

Q. In your opinion, is the NHS facing a funding problem?

When asked what should be done if the NHS needs more money, the proportion of people supporting tax rises has increased eight percentage points in the past two years and now stands at 49 per cent. More specifically, support for a separate (or ‘hypothecated’) tax to directly fund the NHS – an option raised in the Select Committee’s report – stands at 28 per cent in the new BSA findings. An Ipsos MORI poll conducted this year showed that raising National Insurance attracted majority support, while raising Income Tax was a little more unpopular.

Figure 2: If the NHS needed more money, which of the following do you think you would be prepared to accept?

2014 (%)2015 (%)2016 (%)2017 (%)
Pay more through the taxes I currently pay17172126
Pay more through a separate tax that would go directly to the NHS24242835
Pay for non-medical costs in hospital, like food and laundry1212118
Pay £10 for each visit to a GP or local A&E department14151411
Ending exceptions from current charges3352
None of the above; the NHS needs to live within its budget27262015
Don't know3212
Pay more taxes (combined)41424961
Increase costs to service users (combined)29303021

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

The proportion of people wanting to pursue policies that increase the costs to users has stayed the same, while now just 20 per cent think the NHS should learn to live within its budget, a fall of seven percentage points since 2014.

This evidence signals public support for tax rises to plug the financial hole in the NHS. However, there are caveats to this support. First, it is worth bearing in mind that half of the British public would prefer to pursue alternatives to higher taxes. Second, the tax increases that are asked about in surveys remain hypothetical and intangible for many people.

And if consensus over how to pay for additional spending cannot be reached, what should be done? The new BSA data shows that the most popular course of action for an NHS that exceeds its funding allocation would be to stop providing treatments of poor value, though support for this measure has dropped five percentage points since 2014. Instead, there has been a corresponding increase in support for restricting access to non-emergency treatments, although this approach to rationing services remains controversial.

These findings suggest that the public may be ready to talk about how to pay for a sustainable health and social care system, even if a national conversation has not yet begun.

Q. If demand for NHS services exceeds the amount of funding it receives, what do you think is the most important thing for the NHS to do?