Some NHS fees would have conditional support

Radical changes to NHS funding, including user charges for some procedures, would be considered by taxpayers, according to research findings. But the public would first have to be convinced that waste was being driven out of the health service and tax avoidance was being tackled.

Although support for this part of the welfare state remains high – in contrast to falling support for working-age benefit claimants – the number who believe that there should be no limits on what is spent on the NHS has declined since 2006, according to a study by Ipsos Mori for the King’s Fund.

The fund, which sought to examine the public appetite for changing the way the health service is funded in an era of austerity, says its research “suggests that more people are starting to accept that there might need to be limits and public spending is not infinite”.

The fund said that in the past 50 years, spending on the NHS had risen from 3.4 per cent to 8.2 per cent of gross domestic product.

The government has vowed to maintain a real-terms increase for health in the 2015-16 spending round, but the impact on other departments’ settlements could make it harder to sustain this, and a more fundamental public debate about how to fund the health service cannot long be postponed, argues the fund.

At sessions in London and Leeds, it sought the views of two groups of 40 people on the funding of the NHS and “possible future funding challenges”.

A key lesson for ministers was that participants were “wedded to the fundamental principles underpinning the NHS; that it is universal, comprehensive and of high quality”.

Anna Dixon, the King’s Fund director of policy, who led the research, said “a more divisive view of the welfare state” had marked the debate over the benefit changes which had been “portrayed as half of us pay for the other half . . . where in the NHS there is a view that it is there for everyone: everyone pays in and everyone benefits”.

It was clear that the public would have to be convinced “that money is being spent wisely, and that all other options have been exhausted before they are ready to see any of these principles eroded”, said the fund.

The reactions of these groups suggest, however, that charges could be introduced incrementally for some services seen as discretionary, such as primary care walk-in centres. The fund uncovered a significant body of feeling that those whose conditions were linked to their lifestyles should be expected to contribute towards the cost of their care.

Dr Dixon said charges were seen as “the least worst option” for a cash-strapped health service, but participants were clear that there should be exemptions for people on low incomes.

People who took part were surprised to discover how much was spent on the NHS. Better information might help maintain support for the current level of taxation “or indeed higher levels”, says the fund.

But Dr Dixon said participants wanted to see the government making more progress in closing tax loopholes and tackling tax evasion and avoidance before they would countenance paying more in tax.