Responsive policy: the public’s view on funding and delivering NHS care

Original post from The Health Foundation

‘……..Ben Gershlick

The starting gun for general election season went off this week. We’re only treated to one month of electioneering, but polls suggest it’s still all to play for. We know that the NHS is the most important issue for people when deciding who to vote for.

We also know that improvement happens in the NHS, rather than to the NHS. So don’t expect the standard of care to suddenly rocket up. But one thing is truer than ever: politicians will be listening to what the public think and what the public want, trying to pick up on any chances to strike a chord with the electorate.

We have some idea of what the last five years has looked like for the NHS (set out in our finance and quality briefings), but we have much less idea into what the public think about the NHS.

We wanted to dig a little deeper into some of the results from our work with NatCen on the British Social Attitudes (BSA) survey, and get people’s updated thoughts about the NHS right at the beginning of election season.

In an effort to understand the public’s opinion of the NHS, we partnered with Ipsos MORI to ask 1,792 people about the NHS (308Kb) pdf-file . The polling was all done face-to-face, and the data are all weighted to the known population profile. The maximum margin of error (uncertainty due to sampling) is 2.3%, but for most results the uncertainty is much less.

<div style=”margin-bottom:5px”> <strong> <a href=”//” title=”The issues shaping debate on the NHS: what the public thinks” target=”_blank”>The issues shaping debate on the NHS: what the public thinks</a> </strong> from <strong><a href=”//” target=”_blank”>The Health Foundation</a></strong> </div>

One thing is clear: public opinion hasn’t swayed and rocked massively over time, and these results back up what we saw in the BSA survey. If politicians are trying to track public opinion, you’d hope stable public opinion leads to long-term thinking when it comes to policy in the NHS.

So, if politicians are sincere about listening to the public, here are a couple of things they can take on board:

The public want the NHS protected from cuts, and are happy for taxes to be increased to fund it

More than 8 in 10 (85%) of the public want the NHS protected from cuts. Next in line were schools (49%) followed by care for the elderly (45%). More than three times as many people wanted the NHS protected than wanted the police services protected (27%). People were asked to pick two or three things that they wanted to protect, so some of the less common options may just be a little off their radar.

The NHS is likely to be the only public service that won’t be cut in the next parliament, no matter which party (or concoction of parties) ends up in power. This seems to chime with public opinion.

Realistically, given the political and public desire to decrease the national deficit, total public spending is going to decrease over the next parliament.

So how do you protect the NHS (which accounts for £1 in every £5 of government spending) and reduce government spending? You spend less money on other public services, or you raise more money.

The public are clear on their preference: raise more money.

Of those surveyed, 59% wanted increased taxes in order to maintain the current level of spending, care and services through the NHS. Just 21% wanted reduced spending on other services, and only 7% wanted a reduction in the level of care from the NHS in order to avoid increased taxes or cuts to other public services.

Of course, revenue can be raised by the NHS, for the NHS, through charging people to use (or not use) services. But our polling shows that there is very little appetite for a £10 fee to see your GP (just 15% support this) and increasing prescription charges (slightly more, but still just 30% support this).

One charge that does seem to resonate is a £10 fine for missed appointments – 61% support this, and it’s easy to see why. It seems it would help reduce waste in the NHS (we know half of the public think the NHS wastes money); it seems ‘fairer’ than the other options; and seems like it would raise money.

In reality, we don’t know if the £10 fine is a good idea: are missed appointments wasteful, or do they give GPs a chance to catch up on admin? Is it fair, or will it disproportionately affect those with mental health issues or demanding work lives? Is it a good way to raise money, or is it a drop in the ocean of the potential £65bn funding gap by 2030/31? And might it lead to people missing out on early diagnosis and ending up needing emergency care? Will it even raise enough money to justify the costs of administration?

The polling also found that while people currently think the NHS is free at the point of use, people are less convinced that it will be in five years’ time. Only a quarter of people strongly agreed that it will be free, compared to almost double that (47%) thinking it currently is.

Most do not see non-NHS provision as damaging to the NHS

We know from our previous polling with NatCen that people’s most common opinion is indifference to who provides their care. We wanted to dig a little further: while many don’t have a preference for who delivers their care, we didn’t know if they still objected to further non-NHS provision. Our polling shows that most people don’t think that further non-NHS provision will make the NHS worse.

This is a really tricky issue, as our briefing on competition sets out. Over time an increasing percentage of the NHS budget has been used to buy services from non-NHS providers. In 2013/14, 10.8% of total commissioner spending in England was used to buy care from non-NHS providers. This is likely to be an underestimate as this figure excludes spending on independent contractors such as GPs. The evidence is unclear on whether this increase in the use of non-NHS providers has led to improvements in the quality of care. But it’s clear that a large proportion of people are open to the potential benefits of more diverse provision.

In our publication Three tests for a credible health policy we set out the challenge all political parties face. The public attitudes in this new polling don’t make the challenge easier. But it’s only through engaging with people that we can understand what they want from the NHS.

We know people are willing to make tough decisions, and they will expect the same from the political parties. Let’s not be scared to let the voice of the people be heard: not just in the polling booths but also in the policies.

Ben is a Policy and Economics Analyst at the Health Foundation,  ……..’


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