in May. Photograph: Tayfun Salcı/EPA
Seven in 10 people in the UK believe charges for NHS care will creep in over the next decade, ending the health service’s record of being free at the point of use, polling has found.
One of the NHS’s key founding principles from 1948 is in peril, 71% of the public believe, according to the survey carried out for the Health Foundation ahead of the service’s 75th birthday this week.
Despite almost three in four people saying the NHS in its current free form is “crucial”, 51% say they expect to pay for some services within the next decade, while 13% think most services will need to be paid for upfront and 7% anticipate charges for all services.
Tim Gardner, an assistant director of policy at the Health Foundation, said the thinktank interpreted the findings as an “expression of concern that what the public values the most about the NHS – affordable care provided free at point of use – may be under threat”.
He said: “The durability of the principle that the health service would provide care based on need not ability to pay has been regularly questioned throughout its history, especially at times when the service is under great pressure.”
There had been growing calls for radical changes, such as charging for GP appointments and A&E visits, added Gardner.
Politicians such as Rishi Sunak, the prime minister, Liz Truss, his predecessor in No 10, and the former chancellor and health secretary Sajid Javid have all backed one or both of those ideas as potential ways of raising more money for the NHS and reducing demand. Critics dismissed them as “zombie” ideas that were impractical and would not help.
The Health Foundation survey of 2,540 over-16s, conducted by Ipsos, was carried out at a time of huge pressure on the NHS owing to the backlog in waiting lists and staff shortages, and as junior doctor and consultant strikes loom this month.
On Sunday Amanda Pritchard, the chief executive of NHS England, urged the government and health unions to settle their dispute as soon as possible, saying patients would “pay the price” for the unprecedented scale of the action. She said strikes must not become “business as usual” for the NHS.
While there is currently a standoff, the British Medical Association (BMA) wrote to Sunak on Sunday asking the government to enter mediated talks to break the deadlock in the junior doctors’ strike and reach a settlement. Steve Barclay, the health secretary, had on Sunday accused junior doctors of “suddenly” walking out of talks.
But Prof Philip Banfield, the new chair of the BMA council, will give a speech on Monday saying it is the government that is refusing to go to Acas or acknowledge that “devastation [on the NHS] has been wrought by successive UK governments”.
Separate polling from Ipsos shows that most Britons support healthcare workers in their wave of strikes over pay and conditions this year despite the worsening disruption, with backing for junior doctors at about 56% in June.
With five days of junior doctors’ strikes followed by two days of consultants’ strikes scheduled for the middle of the month, data shows industrial action has already led to more than 648,000 cancelled appointments, procedures and operations, exacerbating backlogs.
Wes Streeting, the shadow health secretary, said there was “no doubt that having run down the NHS over 13 years, many Conservatives will now use their failure to argue that its founding principles must be abandoned” by making the case for charging. He said Labour would “never let this happen”.
“The future of the NHS will be on the ballot at the next election,” he said. “It was Labour who created the NHS and made sure it was there for us when we need it, delivering the shortest waiting times and highest patient satisfaction in history.
“It will fall to the next Labour government to rescue the NHS from the biggest crisis in its history, and breathe new life into the service so it is still there for us in the next 75 years.”
Daisy Cooper, the deputy Liberal Democrat leader and party health spokesperson, said the Lib Dems would “set out our plans to ensure that we have an NHS fit for the 21st century that remains free at the point of use” before the next election.
“Waiting lists, staff sick days and social care demand are all soaring and only getting worse under this out-of-touch Conservative government,” she said.
The Tory peer James Bethell, who was a health minister at the height of the Covid pandemic, said the situation with waiting lists was already so bad that it constituted “rationing”, but he said he did not think charging for services was a good idea.
He said: “People might be thinking the pressures in the NHS makes charging inevitable but that doesn’t mean it’s either a good idea or that it’s popular. I haven’t seen any evidence that charging will improve outcomes.”
He argued for “a new contract between the government and the public that is not just a one-way promise for free access but is more of a partnership around healthy living”.
“That requires leadership from government to create an environment where ordinary people can make realistic healthy choices and are supported to fight disease,” he said.
“Instead too many of us are constantly battling against junk food, mouldy homes, dirty air, toxic workplaces and addictive algorithms that drive us to porn, casinos and depression, and losing the battle with huge costs in health, care, benefits and productivity.”
With the NHS struggling, the Health Foundation survey shows people appear to have little faith in politicians’ promises to keep the NHS free, even though they would overwhelmingly like to see its current model continue.
According to the survey, the NHS ranks highest as people’s first choice when asked what makes them most proud to be British – compared with democracy, culture and history – at 54% of those surveyed.
The data also revealed the public are pessimistic about the NHS’s ability to meet key future challenges, with 77% believing the NHS is not ready for the increasing health demands of an ageing population.
It found some degree of split along political lines, with 66% of people intending to vote Conservative more likely to expect user charges for some services compared with 51% of Labour voters.
A senior Tory source said: “The NHS is our most treasured national institution and we are fully committed to its founding principle of healthcare for all, free at the point of delivery.
“As we celebrate its 75th anniversary this week, we have backed the NHS’s long-term workforce plan with an extra £2.4bn of investment to cut waiting lists and put the service on a secure footing long into the future.
“For the NHS to carry on caring for us all for the next 75 years and beyond, we need a strong economy, and the biggest threat to that is Labour’s plan for a £28bn annual spending splurge fuelled by uncontrolled borrowing.”
About 80% of those surveyed think the NHS needs an increase in funding, compared with 17% who think it should operate within its current budget, with some degree of support for a dedicated NHS tax (31%), an increase in national insurance (22%) or an increase in income tax (21%).
The NHS in England is due to receive only a 1.2% increase to its budget this year – a third of its historical average of 3.6% – despite long waiting times, growing patient dissatisfaction and increasing alarm that it is “broken” and unable to provide urgent care quickly.
