How should we pay for health care in future?

In order to contribute to an informed public debate about the level of future spending on health and social care, and about how that spending might be funded, Ipsos and the King’s Fund worked in partnership to hold two deliberative events 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. The research found that:

• 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 (e.g. ‘hotel’ facilities).
• Overall, many understood that the NHS is under pressure, but few accepted that this would 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.

Video Interviews

How surprising are the costs of funding the NHS? On behalf of The King's Fund, we spoke to a number of people about the cost of running the health and social care system at our deliberative event.

• Play the video

On behalf of The King's Fund, we asked members of the public for their best idea for solving the NHS funding issues. From receiving a bill for services to introducing community health officers, you can hear their opinions in this short video.

• Play the video

Ipsos Chief Executive, Ben Page said: ‘The public have always said they are willing to go to great lengths to protect current NHS services, preferring to exhaust all other options before cutting NHS spending. Whether they appreciate the scale of the financial challenge facing the NHS is another matter.’

Technical note:

• Two deliberative events with members of the general public were held in London and Leeds on 20th October and 10th November 2012 respectively.
• In order to ensure that events reflected the local populations, participants were recruited based on a number of criteria including social grade, age, and ethnicity.