The King’s Fund on Funding

Elliot Bidgood, 16 April 2013

Though the Department of Health budget was nominally ‘ring-fenced’, the NHS currently faces perhaps the biggest funding challenge in its history, as the service tightens its belt and the cost of the current reorganisation and long-term cost pressures (ageing, obesity, drugs & technology) bite. It is against this backdrop that The King’s Fund and IPSOS-MORI published their research yesterday on public attitudes to future healthcare funding, gleaned from two deliberative events. 40-50 people were invited to each event – they included a spread of demographics and political affiliations, carers, people who use the NHS to varying degrees and private insurance holders, while excluding research and health professionals. From this, The King’s Fund were able to report some very interesting findings:

• “Participants strongly supported the founding principles of the NHS, and yet recognised the shortcomings and challenges it faces. There was good understanding about how the NHS is currently funded, but people wanted to know more about how that money is spent.”
• “Although many felt removed from the decision-making process at present, there was a sense among some participants that the public should have more influence on how the government allocates funding.”
• “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 insurance schemes, particularly voluntary insurance.”
• “Some supported introducing user charges for ‘not clinically necessary’ procedures and for needs resulting from inappropriate lifestyle choices or misuse of the system…There was support for being able to pay to enhance non-clinical aspects of care (for example, hotel-style facilities).”
• “It emerged that participants’ decisions about charging were guided by a number of principles. These included whether services were perceived as necessities or luxuries, whether the service being used was elective or an emergency, whether the person could be said to be responsible for their ill health, and whether providing a service free now might prevent higher costs later.”
• “People want to be involved in decisions about NHS funding, and any changes would need careful explanation and a public debate…The public’s attachment to the founding principles of the NHS and reluctance to embrace radical change to the current funding model suggest that an incremental approach is likely to be more acceptable”
• “Some groups thought that voluntary and religious organisations and charities could play a more significant role in health care delivery, research and education”

The desire of some to know more about funding and decision-making and to be somewhat more engaged in these processes is particularly notable, as this is perhaps a relative weakness of the NHS central funding model compared to more hypothecated funding mechanisms that involve more local or payroll taxes. One participant speculated that “It would be interesting to know what percentage of our tax goes to the NHS”, while another asked “How many of us here are clear about what the budget is, how it is arrived at and how we can influence how it is spent? It should be us here around the table.”

NHS financing will continue to be a huge debate in the coming years, but this investigation is a welcome contribution, giving us a qualitative insight into some of the principles, concerns, questions, aspirations and nuances that underpin British public opinion.