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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.
Presentation
The King's Fund, in collaboration with Ipsos MORI, held two deliberative events with members of the public, one in London on 20 October 2012, and one in Leeds on 10 November 2012, to discuss how we will pay for health care in future.
Anna Dixon used these slides during these events to introduce the current state of the NHS, current perceptions of the NHS, and some of the issues that we might face in funding the health and social care system in the future.
These slides do not represent The King's Fund's views on how the NHS should be funded in the future, but were used as a prompt for group discussions on the challenges the NHS faces and how it is funded.