Election 2015: Politicians need to get in step with the public's NHS love affair

For years the political consensus has been that there could be no new money for the NHS. In many ways the sector itself has been complicit in this.

Health commentators have almost appeared embarrassed that health services received the prioritisation that they did in the 2000s.

‘Public opinion is now ahead of political positions’

The best that the NHS could hope for was to be shielded from the icy chill of real term cuts felt elsewhere in the public sector.

Yet, faced with seemingly daily stories about a service struggling to meet rising demand with falling resources, public opinion is now ahead of political positions.

Willingness to pay

Exclusive polling undertaken by ComRes for Incisive Health shows that half the public (49 per cent) say they are willing to pay at least 1p extra in income tax to support the NHS.

This rises to 60 per cent among those who expressed an opinion - i.e. excluding those that said “I don’t know”. Of these, over one-third (35 per cent) say that they are willing to pay an additional 2p or more in income tax.

‘Willingness to pay increased taxes for the NHS is consistent across all age groups’

Although willingness to pay increased taxes for the NHS is highest amongst those over the age of 55 who might expect to be higher users of NHS services than younger generations, sentiment is actually relatively consistent across all age groups.

Even among 25-34 year-olds, 45 per cent express a willingness to pay more income tax for the NHS, compared to 34 per cent who are opposed.

The shifting political landscape

The findings suggest that the political landscape has shifted on funding for health, and not in the way that some policymakers had expected. There has been the usual rash of commentators “thinking the unthinkable” by arguing for various forms of charging to cover shortfalls in funding.

From subscriptions to see your GP to charges for drunks in accident and emergency, these ideas are as unworkable as they are unpalatable. There is, after all, a reason they are “unthinkable”.

Yet the public seems to favour a more straightforward approach: increasing taxes. The extent of support that now exists for higher income taxes to fund health services will make political decision makers sit up and take notice.

We know that debates are raging within all parties about whether to commit to tax increases to pay for the NHS.

For Labour - desperate to make the NHS a flashpoint in the run up to the next election and no doubt heartened by recent increases in the salience of health with the public - committing to tax increases for health would undoubtedly catapult the issue up the political agenda.

Within England, the public’s professed willingness to pay more tax to support the NHS is highest in the North West (56 per cent). It won’t have gone unnoticed by party strategists that this region contains 14 target constituencies.

‘Debates are raging within all parties about whether to commit to tax increases to pay for the NHS’

Of course, there is risk for a party still grappling with a tax and spend reputation from the pre-bust boom. There is always a difference between what the public say and how they end up voting.

It is, however, worth remembering that previous tax increases for the NHS - when accompanied by clear explanations of where and how the money would be spent - have found public support.

For the Conservatives, increasing spending on the NHS would take a leaf out of its playbook from the last election. It could be a good way of attempting to neutralise the inevitable attacks from the opposition at a time when key NHS performance indicators are heading south.

However, even maintaining expenditure over the course of this Parliament proved unpopular with elements of the Conservative Party. How would they react to tax increases explicitly for this purpose?

Interestingly it is the Liberal Democrats, battling with their own trust issues after their bruising experience over the Health and Social Care Act, who have so far been the clearest in response to our research.

Norman Lamb has committed to undertaking “a thorough review of NHS costs and funding to ensure the long term sustainability of the health service”.

Listen to the public’s NHS love affair

The initial coverage of our study attracted over 1,000 comments in the first 48 hours, demonstrating the public interest in the issue, as well as the strong feelings that it generates.

Tax is rarely a comfortable issue for politicians, but neither is being behind public opinion. NHS England’s five year forward view is likely to increase the political heat by making clear the implications of failing to deliver adequate funding.

‘Politicians may well decide that the downside of failing to deliver for health outweighs the risk associated with tax rises’

Spending on the NHS is now falling as proportion of GDP. The OECD’s figures show that - despite the pledges of the Blair years - spending on health services is still much lower than in countries such as Germany, France, Sweden or Denmark.

The simple truth is that you get what you pay for; if we spend less on health than other countries then we are likely to get poorer outcomes.

With the public’s love affair with the NHS showing no signs of abating, politicians may well decide that the downside of failing to deliver for health outweighs the risk associated with tax rises.

Mike Birtwistle is a founding partner of Incisive Health