Published on 18 September 2017
- Our Work
- The Reformer Blog
14 February 2018
2018 began with two big domestic policy questions: should ministers inject more money into the NHS? And how does government work with independent companies to provide public services?
These questions arose from the NHS winter crisis, which saw increased waiting times in A&E, higher-than-usual hospital admissions and some surgery being cancelled, and the collapse of Carillion, a large construction firm which held 450 contracts to supply public services, from building hospitals to maintaining schools.
These questions, of taxation and the provision of public services, are at the heart of how government functions. The trade-offs deserve careful thought. Reform commissioned a poll to understand voters’ views on NHS funding and public-private partnerships.
Strong support for NHS reform
The poll shows that a majority of voters (58 per cent) believe that the NHS needs reform more than it needs more money. This is a reality check for policymakers, from all sides of the debate (including Boris Johnson, Jeremy Corbyn and Simon Stevens), who have argued for extra money to solve the NHS’s problems.
Reform research has consistently concluded that reform to the NHS, through moving care from hospitals into the community, using nurses and pharmacists to deliver more care, and exploiting game-changing technology to remove administration and deliver care can deliver this reform, while keeping spend under control.
Support for extra NHS spending but within tight limits
The poll did reveal, however, that a larger proportion of voters than in previous years would be willing to pay more income tax to fund more spending on the NHS — 59 per cent compared with 33 per cent in August 2014. The average median increase in income tax voters are willing to pay is only 0.42 pence in the pound, however. This, £2 billion a year, is less than the penny in the pound the Liberal Democrats argue for and the £5.2 billion Mr Johnson reportedly wanted.
The message is clear for ministers: voters will back reform to the NHS with a little more money (around 2 per cent of the NHS’s budget), but expect services to change to deliver better care.
Pragmatic support for mixed provision of public services
The poll also revealed that a majority of voters (64 per cent) believe that it should not matter whether hospitals or surgeries are run by the government, not-for-profit organisations or the private sector provided that everyone has access to care. This is 2 per cent higher than in 2014, despite the poll being commissioned on the day Carillion went into liquidation.
This is an important message for politicians who have questioned the premise of the outsourcing model following Carillion’s liquidation. The reality is that public services would grind to a halt without private and third-sector involvement. Almost one-third of government spend (£242 billion) is spend on external providers for goods and services from paperclips to the trident nuclear deterrent. The NHS spent £54 billion on external suppliers in 2014-15. This model has delivered value for money through increased competition. While the execution of some contracts can be improved, it seems voters are more concerned with access to services than ideological arguments on either side.
Marking the argument for reform
These findings should give policymakers confidence to argue for the reform of public services. Voters believe the NHS needs to change, and many are willing to make a small contribution to the cost of this. Most voters are agnostic about who the Government works with to achieve reforms, so long as public services are accessible to all.
These findings provide guidance on 2018’s big policy questions. It is now over to policymakers to deliver these reforms.
Alexander Hitchcock, Research Manager, Reform