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What do cancer patients want from the NHS? What can the NHS afford?
Laura ThomasIpsos MORI Social Research Institute23 February 2012
A thought experiment
£750k per patientExtends life by a month
£10k per patientExtends life by 10 years
Consider two new treatments...
What’s acceptable to the public?
What’s the tipping point?
How will this change over coming years?
Services more explicitly rationed
… and social media mean people can organise
Public hit in their own pockets
Union unrest – can’t rely on
staff as advocates
So why is this important?
Context for QALYs very different now to a few years ago
The new context likely to shape what the public see as “acceptable spending”
NHS needs to be ready for what is likely to become an increasingly vocal debate
Producers need to be sensitive to the public opinion constraints on the NHS
So where will public priorities land?
6
Some slides from a few years back
7372
73
2527
23
0102030405060708090
All ABC1 C2DE%
Q10 Which of the following statements best reflects your thinking about the NHS?
Base: English adults age 16+ (c.1,000 per wave)
The NHS is crucial to British society and we must do everything to maintain it
The NHS was a great project but we probably can’t maintain it in its current formDon’t know
7Base: British public, 18+ (1,001) 12-17 January 2006
But by everything, they mean...
8%
48%
44%
Agree
Disagree
Don’t know
There should always be limits on what is spent on the NHS…
unlimited spending...
31% strongly disagree
8
31%
41%
28%
The NHS should provide all drugs and treatments no matter what they cost
Base: British public, 18+ (1,001) 12-17 January 2006
and little concern about value for money……
The NHS should provide the most effective drugs and treatments no matter what they cost
The NHS should provide the most effective drugs and treatments provided they represent good value for money
72% expect NHS to provide drugs no
matter what they cost
no matter what they cost
treatments no matter what they cost
Before deliberation
the most effective drugs & treatments no matter what they cost
Don't know
all drugs and treatments no matter what they cost
the most effective drugs and treatments provided good value for money
14%
64%
22%
After a day’s deliberation
15%
47%
34%
4%
… which are deeply entrenched
Base: British public, 18+ (90) Birmingham
NHS should provide:
78% “no matter what costs”
62% “no matter what costs”
Q. “Which of the following do you agree with the most?
But around election, some signs of shift
Recognising the limits to public services...
“I’ve got a particular beef about dental care, you see people who totally abuse that, that feed their kids nothing but sweets … and it’s really hard to get an NHS dentist now.”
Focus group participant, London, April 2010
12
Not a blank cheque
“George Best being given a new liver – that to me, repeatedly doing damage to themselves, it makes me feel quite angry actually … there’s huge waiting lists for other people that have serious health problems that aren’t their fault and people like George Best are running the gauntlet again.”
Focus group participant, London, April 2010
Making judgements about “good” and “bad” NHS spending
“The NHS will give out things like boob jobs and gastric bands, so why won’t they give my son a chance at happiness?”
Metro, 5th July 2010
7
42
38
43
55
15
Base: 1,646 British adults 15+, 23-29th April 2010 • Source: Ipsos MORI Health Insight Unit/Personal Responsibility (CAPIbus questions)
The NHS should give less priority to people who do not take care of their health
It is the job of the NHS to keep people healthy
It is the individual’s responsibility to keep themselves healthy
The NHS should be there to take care of people regardless of why they are ill
Base: 1,646 British adults 15+, 23-29th April 2010 Source: Ipsos MORI Health Insight Unit/Personal Responsibility (CAPIbus questions)
But it’s not clear where this trend will net out
What’s more certain: challenging times ahead
“There is a tsunami of anger heading towards the NHS which
will overwhelm people paddling in their canoes acting as if nothing is
happening”
Sir Robert Francis QC
15%
13%
15%
20%
46
39
55
35
35
44
27
39
4
4
3
5
Base: 1,003 British adults 18+, 17th – 19th June 2011
% Worse% Better
Standards of treatment for patients in the NHS
The service provided by GPs or family doctors
How efficiently the NHS spends public money
Source: Reuters/Ipsos MORI
Is he right?
Thinking about the NHS and from what you know or have heard, do you think the following will get better or worse over the next 12 months or will they stay the same?
The length of time patients have to wait before receiving treatment
% Stay the same % Don’t know
Do you recognise the headlines?
Mortality lottery in NHS Guardian, 15 Jan 2001
Cancer victim forced to buy her own drugs
Daily Mail, 4 April 2001
Care hit by staff shortages, say nurses
Guardian, 18 Sept 2001
Huge differences in the number of doctors per bed at hospitals dramatically affect a patient's chances of survival, according to a study.
Daily Mail, 15 Dec 2001
Cash crisis is crippling us, say hospitals
Daily Mail, 21 Feb 2001
NHS reforms look tarnished
BBC, 4 May 2001
NHS rationing on way, say doctors
BMA says extra resources not enough to meet demand
Observer, 7 Feb 2001
0
10
20
30
40
50
60
70
May1997
May1998
May1999
May2000
May2001
May2002
May2003
May2004
May2005
May2006
May2007
May2008
May2009
May2010
May2011
So will public concerns peak again?
NHS
Crime/ Law & Order
Race/ immi-
gration
Economy
Source: Ipsos MORI Issues Index
What do you see as the most/other important issues facing Britain today?
Unemployment
Base: representative sample of c.1,000 British adults age 18+ each month, interviewed face-to-face in home
So...
A possible shift away from “NHS should fund everything”...
... Towards willing to make judgements about what NHS spending is acceptable
Public don’t currently have appetite for withholding treatments
But we can anticipate public anger – will that: Change their views on what’s acceptable?
Make them more vocal in expressing that?
What about the wider context?
85%
55%
A pretty clear story ... society is becoming less compassionate
Source: British Social Attitudes Survey 2010
The state has a duty to provide a decent standard of living for the unemployed
1985 Now
51%
38%
Government should redistribute wealth to help the poor
1994 Now
01020304050607080
April '97 November '00 April '05 June '09
%
...and fewer support extending services
Tax cut/reduce servicesThings left as are
Don’t know
Tax increase/extend services
People have different views about whether it is more important to reduce taxes or keep up government spending. How about you? Which of these statements comes closest to your own view?
Source: Ipsos MORI Base: c.1,000 British Adults
% Taxes should be cut, even if it means some reduction in government services, such as health, education and welfare
% Don't know
% Things should be left as they are
% Government services such as health, education and welfare should be extended, even if it means some increases in taxes
46%
33%
18%
2%
48%
33%
41%
56%
43% 43%
49%
59% 57% 59%
44% 44%
45%
32%
37%32%
20
30
40
50
60
Jun
-09
Au
g-0
9
Oct-0
9
De
c-09
Fe
b-1
0
Ap
r-10
Jun
-10
Au
g-1
0
Oct-1
0
De
c-10
Fe
b-1
1
Source: Reuters/Ipsos MORI Political MonitorBase: c. 1,000 British adults each month
Agree
Disagree
There is a real need to cut spending on public services in order to pay off the very high national debt we now have
Or is it so clear? Second thoughts…?
35%
55%
10%
41%
38%
21%
From what you know, do you think the government has on the whole made the right decisions or the wrong decisions about where spending cuts should be made?
More now think the government is making the wrong decisions on spending cuts
Source: Reuters/Ipsos MORI Political Monitor
Base: 817 British adults 18+, 20th October 2010
Right decisions
Wrong decisions
Don’t know Right decisions
Wrong decisions
Don’t knowOctober 2010 March 2011
Base: 1,000 British adults 18+, 11th - 13th March 2011
So back to our thought experiment...
A thought experiment
£750k per patientExtends life by a month
£10k per patientExtends life by 10 years
Consider two new treatments...
What’s acceptable to the public?
What’s the tipping point?
How will this change over coming years?
Unclear where the public will land on this?
Unprecedented times – and views still evolving
Discord between what people think in theory and in practice
Likely to be public anger – but where will it focus
Govt for cuts?
NHS – for not spending enough?
NHS – for spending too much?
BUT...
Views will form – which will shape the tipping point: what spending people see as acceptable
Commissioners need to be sensitive to emerging public priorities
