The following article about the release of the SMF's paper Local Control and Local Variation in the NHS: What do the Public Think? appeared on the National Health Executive website:

Think tank research shows people prefer postcode lotteries in the NHS

 

Research by the Social Market Foundation shows that while people say they want a nationally based NHS, when asked how resources should be allocated in their area the public supports locally tailored services

 

The key to allaying people's concerns about changes to local services is ensuring that decisions are transparent and fair.

 

As part of its two year research project examining the future of the health service in a world of technological change, an ageing population and rising consumer demand the SMF, with Ipsos-MORI, conducted opinion polling to find out public views about variation in the NHS, followed up with a series of discussion groups to explore people's views in greater depth.

 

When questioned, around 75% of people say they want a service based on national standards, with treatments only available if they are available across the whole country. However, when taken through an exercise in allocating resources, all groups choose to offer specialist services for particular local need rather than improving national standards - a ‘postcode lottery'.

 

People are willing to accept that different healthcare services may be delivered in different areas if there is greater involvement in decision making, and this feeling is strongest among those on low incomes. Only 20% think decisions about what is available on the NHS should be made solely by professionals. 30% of people categorised as "Hard pressed" think public should be much more involved, compared to 19% of people who are ‘comfortably off'. However, few people are willing to give up their time to get involved - most think it is more important to have a say when things go wrong.

 

Commenting on the report, Health Project Leader at the SMF David Furness said:

 

"The crisis in public finances means that health services will be severely stretched in the years ahead. Efficiency will only be improved with a greater focus on local priorities. Our research shows that people will accept local variation in the NHS if they feel their views are taken into account - fears about postcode lotteries are largely misplaced."

 

The polling went on to ask given the economic position and the pressure on public finances, how should any shortfall in health funding be met. Over 59% of respondents said any shortfall should be addressed through some form of prioritisation rather than an increase in taxes. The research showed that prioritisation means different things to different age groups. Older people tended to view priority setting as the same thing as efficiency, while younger people believed that priority setting means considering what should and should not be available on the NHS.

 

Commenting David Furness said

 

"Cutbacks in public service budgets will inevitably mean some tough choices about what is available on the NHS. Many people accept that this will mean that some things will no longer be funded by the NHS, with a real focus on what is clinically effective. Some people even suggested charging for services as a way of encouraging people to avoid using health services unnecessarily. Clearly the political ground is shifting as people begin to understand the likely impact of the downturn on public services."