BMJ 2015;350:h1082 doi: 10.1136/bmj.h1082 (Published 25 February 2015)
Page 1 of 2
News
NEWS People do not want cuts made to other public services to protect NHS, survey finds Ingrid Torjesen London
The public thinks that the NHS wastes money, and people are not willing to see further cuts to other public services to preserve current NHS services, the British Social Attitudes (BSA) survey has found.
The NHS chief executive, Simon Stevens, has said that the NHS will need at least an extra £8bn (€10.9bn; $12.4bn) to plug a funding shortfall by the end of the next government term to protect services.1 The authors of the survey report, Public Attitudes to the NHS,2 said that this raises important questions about where this money should come from and how the NHS should be funded in the future. A total of 2878 people in Britain were questioned during the summer and early autumn of 2014 for the BSA survey. Most respondents (89%) supported the principles of a tax funded NHS that is free at the point of use and provides comprehensive care. Labour supporters were slightly more likely to have this view.
However, more than half (51%) of those surveyed believed that the NHS often wastes money, and this view was more common among older people (more than 60% of those aged 49 and older, compared with just a third of those aged 35 and under) and among Conservative and UKIP supporters. Most respondents (58%) were unwilling to see the government spend less money on other public services to maintain current NHS services. Only people who had recently been hospital inpatients themselves were more likely to support cuts in other public services than to oppose them.
Ben Gershlick, policy and economics analyst at the Health Foundation, which produced the survey report in partnership with NatCen Social Research, told a press conference, “So, what it looks like is that those who have been an inpatient are much more willing to cut other services to support the NHS; whether that is because they get a gain from the NHS being shored up or because they see in reality how the NHS is faring is not quite clear.” With the NHS set to be a key issue in the general election in May all political parties have pledged extra cash, but Anita Charlesworth, chief economist at the Health Foundation, said that a more long term view is needed.
“For at least a generation it has been the experience of the politicians and the public that you can spend much more on the NHS and not feel like you are paying for it [by taking it from other services]. The opportunities to continue to do that are very limited, if not exhausted, and I think we are reaching a crunch For personal use only: See rights and reprints http://www.bmj.com/permissions
point where I think the public understands that,” said Charlesworth.
She added, “What we haven’t been able to do is to say, if that way of operating has come to an end, what are we going to do instead? You either tax more to fund the NHS, or you start to think of other revenue streams. “You cannot have that debate with the public until the public is convinced that you are eliminating the waste and spending their money wisely.”
Charlesworth said that the NHS needs “to demonstrate to the public in a more convincing way that it is eliminating waste and using every pound wisely,” but she added that the efficiencies demanded of the NHS (4% a year) were almost double what is expected from the economy (2%). As the NHS is a service industry where direct care is one of the defining features of quality, most analysts would expect its productivity to be slightly below the rate of productivity growth in the economy as a whole, she said. This is backed by research evidence showing that, over the past seven or eight years, NHS productivity has grown by about 1.5% a year on average. The survey also looked at the public’s attitude to NHS inpatient care provision by the private sector. Most people (43%) expressed no preference as to whether they were treated by an NHS service or by a contracted private or third sector provider, but those who expressed a preference were most likely to prefer the NHS (39%). Older people were more likely to express a preference for the NHS, as were Labour voters, followed by Liberal Democrat voters.
When the 18% of people who had expressed a preference to be treated in a private or non-profit organisation were asked whether they would still be happy to be treated in those sectors even if it meant that their local NHS organisation was at risk of being closed, around half said that they would be. Charlesworth said that these particular findings showed that government policies over the past 15 years to extend patients’ choice of treatment were aligned with what a large proportion of the public want. The younger generation “are even more agnostic about who provides their care than the older generation,” so the pressure on the system is likely to keep increasing to meet that desire for choice, she warned. 1 2
Iacobucci G. NHS plan calls for new models of care and greater emphasis on prevention. BMJ 2014;349:g6430. Gershlick B, Charlesworth A, Taylor E. Public attitudes to the NHS: an analysis of responses to questions in the British Social Attitudes survey. Health Foundation. February 2015.
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BMJ 2015;350:h1082 doi: 10.1136/bmj.h1082 (Published 25 February 2015)
Page 2 of 2
NEWS
Cite this as: BMJ 2015;350:h1082
For personal use only: See rights and reprints http://www.bmj.com/permissions
© BMJ Publishing Group Ltd 2015
Subscribe: http://www.bmj.com/subscribe
Page 1 of 2
News
NEWS People do not want cuts made to other public services to protect NHS, survey finds Ingrid Torjesen London
The public thinks that the NHS wastes money, and people are not willing to see further cuts to other public services to preserve current NHS services, the British Social Attitudes (BSA) survey has found.
The NHS chief executive, Simon Stevens, has said that the NHS will need at least an extra £8bn (€10.9bn; $12.4bn) to plug a funding shortfall by the end of the next government term to protect services.1 The authors of the survey report, Public Attitudes to the NHS,2 said that this raises important questions about where this money should come from and how the NHS should be funded in the future. A total of 2878 people in Britain were questioned during the summer and early autumn of 2014 for the BSA survey. Most respondents (89%) supported the principles of a tax funded NHS that is free at the point of use and provides comprehensive care. Labour supporters were slightly more likely to have this view.
However, more than half (51%) of those surveyed believed that the NHS often wastes money, and this view was more common among older people (more than 60% of those aged 49 and older, compared with just a third of those aged 35 and under) and among Conservative and UKIP supporters. Most respondents (58%) were unwilling to see the government spend less money on other public services to maintain current NHS services. Only people who had recently been hospital inpatients themselves were more likely to support cuts in other public services than to oppose them.
Ben Gershlick, policy and economics analyst at the Health Foundation, which produced the survey report in partnership with NatCen Social Research, told a press conference, “So, what it looks like is that those who have been an inpatient are much more willing to cut other services to support the NHS; whether that is because they get a gain from the NHS being shored up or because they see in reality how the NHS is faring is not quite clear.” With the NHS set to be a key issue in the general election in May all political parties have pledged extra cash, but Anita Charlesworth, chief economist at the Health Foundation, said that a more long term view is needed.
“For at least a generation it has been the experience of the politicians and the public that you can spend much more on the NHS and not feel like you are paying for it [by taking it from other services]. The opportunities to continue to do that are very limited, if not exhausted, and I think we are reaching a crunch For personal use only: See rights and reprints http://www.bmj.com/permissions
point where I think the public understands that,” said Charlesworth.
She added, “What we haven’t been able to do is to say, if that way of operating has come to an end, what are we going to do instead? You either tax more to fund the NHS, or you start to think of other revenue streams. “You cannot have that debate with the public until the public is convinced that you are eliminating the waste and spending their money wisely.”
Charlesworth said that the NHS needs “to demonstrate to the public in a more convincing way that it is eliminating waste and using every pound wisely,” but she added that the efficiencies demanded of the NHS (4% a year) were almost double what is expected from the economy (2%). As the NHS is a service industry where direct care is one of the defining features of quality, most analysts would expect its productivity to be slightly below the rate of productivity growth in the economy as a whole, she said. This is backed by research evidence showing that, over the past seven or eight years, NHS productivity has grown by about 1.5% a year on average. The survey also looked at the public’s attitude to NHS inpatient care provision by the private sector. Most people (43%) expressed no preference as to whether they were treated by an NHS service or by a contracted private or third sector provider, but those who expressed a preference were most likely to prefer the NHS (39%). Older people were more likely to express a preference for the NHS, as were Labour voters, followed by Liberal Democrat voters.
When the 18% of people who had expressed a preference to be treated in a private or non-profit organisation were asked whether they would still be happy to be treated in those sectors even if it meant that their local NHS organisation was at risk of being closed, around half said that they would be. Charlesworth said that these particular findings showed that government policies over the past 15 years to extend patients’ choice of treatment were aligned with what a large proportion of the public want. The younger generation “are even more agnostic about who provides their care than the older generation,” so the pressure on the system is likely to keep increasing to meet that desire for choice, she warned. 1 2
Iacobucci G. NHS plan calls for new models of care and greater emphasis on prevention. BMJ 2014;349:g6430. Gershlick B, Charlesworth A, Taylor E. Public attitudes to the NHS: an analysis of responses to questions in the British Social Attitudes survey. Health Foundation. February 2015.
Subscribe: http://www.bmj.com/subscribe
BMJ 2015;350:h1082 doi: 10.1136/bmj.h1082 (Published 25 February 2015)
Page 2 of 2
NEWS
Cite this as: BMJ 2015;350:h1082
For personal use only: See rights and reprints http://www.bmj.com/permissions
© BMJ Publishing Group Ltd 2015
Subscribe: http://www.bmj.com/subscribe
