Health survey shows demand for higher taxes (CORRECTED)

CORRECTION (PUBLISHED 20 MARCH 1993) APPENDED TO THIS ARTICLE

MOST people favour paying higher taxes or diverting funds from defence to NHS budgets to avert rationing of state health services, according to the biggest opinion survey on health-care priorities undertaken in the United Kingdom.

If rationing is inevitable, however, the public would rather doctors make the hard choices about who gets what treatment and keep politicians out of the decision- making. But if forced to choose, people are more inclined to favour medical intervention that improves the quality of life, such as hip replacements and cataracts surgery, rather than intervention that saves lives, such as heart transplants. The study, presented in London yesterday to a conference on rationing in the NHS, is the first major survey of the public, doctors and NHS managers about priorities in health care. It found that patients and health-service professionals were at odds about whether it was right to ration, and where priorities should lie.

When asked whether the NHS should have unlimited funding or operate under budgetary restraints, 51 per cent of the public said funding should not be limited. Most people supported higher income tax or National Insurance contributions as the best way to raise the level of NHS spending, although about one- third preferred cuts in defence expenditure. People in the 45-54 age group were most willing to pay more tax; younger people were more likely to favour raiding the defence budget.

Only 6 per cent of the public thought that politicians should be involved in decisions about how the NHS spending cake should be sliced up. Most people placed their faith in hospital consultants and family doctors to assess priorities. Middle-aged and professional groups placed most trust in the medical profession to make these decisions. Younger respondents tended to favour more consultation of patients and the wider public. By a two-to-one majority, the public, doctors and managers put quality of life above the saving of life as a broad principle underpinning policy-making, and the older people get, the more they tend to hold this view. The finding endorses, or reflects, the increasing emphasis placed by health ministers on the need to improve primary and community health services, and health promotion, rather than on the hospital sector.

However, when people were asked to rank 10 specific health services in order of priority, heart transplants - one of the most obvious examples of life-saving treatment - was relatively highly rated by the public. Doctors, managers and the public all put childhood immunisation at the top of the list, and cancer treatment for smokers at the bottom.

The public ranked both breast cancer screening and intensive care for premature babies more highly than the two other groups, reflecting perhaps more awareness among professionals of the very high relative costs of these services. Conversely, the public rated mental illness as much less deserving of treatment than did the professionals in the sample.

Doctors gave more priority than the other two groups to disease prevention and quality-of- life measures above life-saving interventions. On the principle of rationing, the professionals were far more supportive of, or perhaps resigned to, the idea. While 51 per cent of the public believed that funding for the service should not be limited, only 17 per cent of doctors, and 2 per cent of managers did. In notes attached to their reply forms, some managers expressed cynical dismay at the 'unrealistic' suggestion that NHS funding could ever be completely demand-led.

Of the one in six doctors who favoured unlimited resources for the NHS, most opted for the so- called 'peace dividend' - cuts in defence spending - to raise the extra money needed, although there was strong support for higher income tax and NICs, too. They were twice as likely as the public to favour 'raids' on the social security budget.

Managers were the most enthusiastic of the three groups about involving national politicians in the allocation of NHS resources.

The survey, carried out across the country within the past six weeks, was commissioned by the British Medical Association, the British Medical Journal, the King's Fund College in London, and the Patients' Association. Some 2,012 members of the public were questioned face to face. Completed postal questionnaires were returned by 800 GPs and hospital consultants, and 250 NHS managers. Chris Heginbotham, a fellow in health services management at the King's Fund College, organised the study and presented the results to yesterday's conference.

'The results overall indicate that a great deal more work is needed to establish the public's awareness about health-care priority setting, and to ensure the public is given more information about costs and benefits of different treatments,' Mr Heginbotham said. 'The Government should take note of the demand for unlimited funding of the health services.'

Two-thirds of voters want the Government to increase spending on the NHS, according to a pre- Budget opinion survey of 1,248 people by the market research organisation Consumer Views.

CORRECTION

Rationing survey

Mori carried out the public opinion survey on health service rationing, quoted in the Independent on 12 March.