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Public remain wedded to NHS funding model says new research by The King’s Fund and Ipsos MORI

The public remain firmly wedded to the fundamental principles underpinning the NHS but under certain circumstances could support the introduction of charges for some treatments and services, suggests a new report, How should we pay for health care in future?, published yesterday by The King's Fund and Ipsos MORI.

The report is based on two day-long events with members of the public to explore their views about how to pay for health care in the future. It follows recent research from The King's Fund into the funding challenge facing the NHS, which showed that, on current trends, health and social care could consume half of all government spending in 50 years’ time.

The events provided fresh insight into people's views about the NHS and how it should be funded. Participants strongly supported the principle that access to health care should continue to be based on need rather than ability to pay, and rejected means testing as a way of controlling future spending. They were also adamant that the quality of clinical care should not be compromised to reduce costs.

Participants were reluctant to consider fundamental changes to the current funding model, even when confronted with the scale of the funding challenge facing the NHS. In discussions about how the funding challenge should be addressed, there was some support for introducing payments for some NHS services and for charging patients in certain circumstances, including:

  • treatments that are not perceived as clinically necessary, eg, cosmetic surgery and elective caesarean sections
  • people who were thought to misuse services, eg, by missing appointments or arriving drunk at A&E
  • patients requiring treatment as a result of lifestyle choices considered inappropriate, eg, smoking or obesity
  • ‘top ups' to non-clinical aspects of care, eg, private rooms and other 'hotel' services

Participants indicated that they want more information about how NHS is currently funded and would like to engage in a debate about how it should be paid for in future. They were also clear that the current system must be shown to be working as efficiently as possible before they would consider changes to funding, and that the government should tackle tax avoidance before asking people to pay more towards the cost of care.

Anna Dixon, Director of Policy at The King's Fund, said:

'Although difficult choices lie ahead, politicians have been reluctant to discuss the future funding challenge facing the NHS. This research shows that people want to engage with these issues. With pressures to spend more on health care growing and the public finances likely to be under considerable strain for the foreseeable future, it is time for an informed public debate about how much we should spend on the NHS and how this should be funded.'

Ipsos MORI 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.’

Notes to editors: 

For further information please contact The King's Fund's Press and Public Affairs team on 020 7307 2585 (if calling out of hours, please ring 07584 146 035). For Ipsos MORI, please call 020 7347 3172 or email

The two day-long events were held in London and Leeds in October and November 2012. Forty members of the public took part in each event, with participants broadly representing the socio-demographic profile of the local population. Each event followed the same format, with a series of presentations followed by group discussions led by a facilitator. This type of 'deliberative' research provides a way of exploring people's views about complex issues that is not possible using conventional polling.

Research published by The King's Fund in January 2013 on Spending on health and social care over the next 50 years showed that the UK currently spends around 9 per cent of its national income on health and social care, more than twice as much as 50 years ago. According to forecasts by the Office for Budget Responsibility, this could more than double again to nearly 20 per cent by 2061. Based on projections for economic growth and current levels of taxation and government expenditure, the research estimated that this would translate to around 50 per cent of public spending.


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