Public spending and the NHS: what do the public think?

It seems that as the focus of the health community moves away from the Health and Social Care Act the debate has begun in earnest about the funding challenge faced by the NHS.

No one working in the sector is under any illusions about the scale of the Nicholson challenge. The question is where are the public on this?

Communicating the concept of cuts to the NHS or thinking about how more money could be found is a task no politician would relish – and for good reason as our polling for the Nuffield Trust demonstrates.

Only a small minority (15 per cent) of people think that no public services should be protected from cuts. Around eight in ten want to see some services protected, with the NHS ranking above all others as the one to protect.

Eight out of ten think that NHS spending should be ring-fenced, more so than schools (51 per cent) or the police (39 per cent). The figure has changed little since we last asked the question in 2009 and is once again illustrative of our deep regard for the NHS and our extreme reluctance to contemplate any reduction in its funding.

This finding, when coupled with the fact that health care was the second most important issue for voters in the 2010 general election, clearly demonstrates how difficult any public debate on this will be.

However, there are some signs the current climate of austerity has had an impact on our thinking. Ipsos MORI’s work for the Department of Health on the public perceptions of the NHS shows that 58 per cent agree that there should always be limits on what is spent on the NHS, up from 44 per cent when we last asked the question in 2006.

This still means 39 per cent disagree, which is a long way from reaching agreement that there should be limits on spending or contemplating cuts.

As part of this work the Nuffield Trust and Ipsos MORI wanted to test three possible funding options with the public. The results are instructive.

It seems the public feel so strongly about the NHS that half (48 per cent) would rather increase taxes in order to maintain the level of spending needed to keep the current level of care and services.

One in five (21 per cent) would opt for reducing spending on other services such as education and welfare to pay for it whilst only one in ten (11 per cent) want to reduce the level of care and services provided by the NHS and thereby avoid tax rises or cuts elsewhere.

Now we need to remember that asking people whether taxes should be increased and asking them to actually pay them are two very different things. Moreover, we did not provide a figure on how much more people might need to pay.

Further work would be needed to determine what might be acceptable. Despite this it is clear that people are willing to consider tough solutions rather than reduce the level of care and service provided. It is this that is perhaps most pertinent to those working in the NHS at the moment.

Tough choices will have to be made on what is provided and they will inevitably meet with strong resistance.

The findings are both unsurprising and sobering. At a fundamental level does the debate come down to cuts or taxes? 

It does not take polling to realise that neither option will be popular. The debate has to happen at some point and this work adds to the body of evidence showing just how difficult this will be.

Dan Wellings is a Research Director at Ipsos MORI. Please note that the views expressed in guest blogs on the Nuffield Trust website are the authors' own.