Sunday, September 19, 1999 Published at 23:03 GMT 00:03 UK
Taxation 'can no longer fund NHS'
Doctors are being forced to ration care
The public no longer believes that the NHS can be funded exclusively by current taxation, a survey has found.
The research, commissioned by the right-wing think-tank the Social Market Foundation, found that most people wanted the NHS to continue to be funded by general taxation.
But the survey also found that most people thought the current system was in its death throes.
According to A Question of Choice, the public expects to have to make some kind of regular payment for their future health care.
Health tax supported
This could either be within the NHS, such as paying for a GP visit, or via a top-up mechanism involving private insurance or other schemes.
The survey also revealed an emerging conflict between the public's desire for more choice within the NHS, and problems arising from rationing made inevitable by its funding mechanism.
There was also a growing perception that healthcare is far better in Europe than in the UK.
Of those questioned 67% expect rationing of healthcare to remain at current levels or worsen over the next decade.
There was support for a hypothecated health tax, and a significant number of those surveyed backed the idea of direct funding of the NHS through user charges.
'Something must give'
The Social Market Foundation issued a statement, saying: "None of this sounds like practical politics today.
"But the public is often ahead of its politicians, and this survey confirms that they understand and appreciate the irreversible logic at the heart of the NHS's problems.
"Something will have to give. And it could be the overall legitimacy of a NHS that gives rise to such conflicts."
Dr Peter Holden, a member of the British Medical Association's GP negotiating team, said he was not surprised by the results of the survey.
He said: "Whatever index you look at, we spend less on healthcare in the UK per head than any other comparable European nation.
"We have got into a culture of low spending on healthcare in this country, and that does not mean that we are efficient, it means that we are simply not spending enough - that is why the system cannot keep up with modern expectations."
Dr Holden said the BMA had studied alternatives to the current system of funding, but had found none to be viable.
He said patient charges would lead to huge sums of money being swallowed by bureaucracy, while an insurance system would inevitably lead to some people being unable to afford healthcare.
A report by the Nuffield Trust on health policy issues for the year 2015 says that, unless there is a radical increase in funding for the NHS through increased taxation or national insurance contributions, there will need to be greater rationing.
It says pressures from increasing drug costs, the rise in elderly people, the public's increasing expectations of the health service, the fact that health is becoming a tradable commodity across national borders and increased reliance on technology are all pushing the cost of the NHS up.