Labour is debating whether to make a bold commitment to extra spending on the National Health Service the centrepiece of its election offer, raising the profile of the service, which is the party's single strongest issue and possibly its best route to forming a majority government in May.
The alternative being discussed is to claim that reform of the NHS, including integration of health and social care, as well as reversal of "government privatisation", will release sufficient funds.
However, a commission for the influential Kings Fund thinktank concluded that while integration of social care and health was necessary, it was unlikely to create large-scale savings.
Polling this week by Ipsos/Mori found that health was the third most important issue facing voters, sitting at only two points behind the economy, which topped the list, with asylum and immigration coming second. Labour has a huge lead over the Tories on health, and it is the issue which forms its dominant lead.
The Guardian reported this week that the NHS was facing a mounting financial crisis with more than half of all hospitals now in deficit and the service likely to end the year almost £1bn in the red.
Separately on Tuesday, David Prior, head of the NHS regulator, the Care Quality Commission, warned that treatment provided by hospitals and GPs was so "dangerously" variable that poor care killed up to 10,000 patients a year.
In an election briefing issued on Tuesday the Kings Fund warned: "The next government will arrive in office with the NHS facing financial meltdown and social care in crisis."
Ed Balls, the shadow chancellor, has already ruled out earmarking a 1p increase in national insurance contributions to help fund the NHS, saying people felt they were already paying too much tax. He has also ruled out an inheritance tax to pay for an integrated health and social care service.
But other sources for temporary funding have not been ruled out, including a "sin tax" on public health polluters. Revenue from tobacco duty in 2011-12 was £9.55bn, up from £8.09bn in 2007-08. The equivalent figures for alcohol duty were £10.04bn and £8.3bn. The Treasury estimates that these taxes each represent 9-10% of NHS spending for those years.
More sin taxes, or a windfall tax, has been proposed by the former Labour health minister Lord Warner, who has suggested that a range of such taxes could reach £25bn by the end of the decade.
New research for Progress magazine, the centre-left Labour journal, prepared by Peter Kellner, the YouGov president, and given to the Guardian shows voters are evenly split on whether they would like to see income tax rise to fund the health service.
YouGov tested four areas of government spending and asked people whether, all else being equal, they would prefer income tax to increase so that more money could be spent, or see income tax fall with less spent, or keep the present balance.
The status quo was the most popular option for three of the four areas: welfare benefits for poor families, state schools, and (more narrowly) state pensions and social care for the elderly.
Only with the NHS did a majority opt for higher tax – though only by a three-point margin ("higher tax/more spending" had 42%; "keep the present balance" had 39%).
The poll also showed that higher tax for spending on the NHS was only a popular option with Labour voters, with 60% supporting the proposal. Only 29% of Conservative voters backed the idea. There have been other polls, including one by ComRes in the summer that found that 49% of people were prepared to pay more tax to help fund the health service, though one in three (33%) of people said they would not be ready to do so, and 18% did not know either way.
By contrast, a more recent Populus poll for Reform, the centre-right thinktank, found that only 33% were willing to pay higher income tax to fund more spending on the NHS, with 67% of voters saying no. A large majority thought the NHS needed reform, not more money.
The danger for Labour of going into the election highlighting the NHS without a funding pledge was pointed out by the Kings Fund.
It said: "The NHS is going through the biggest financial squeeze in its history. Since 2010 its budget has effectively been frozen, increasing by just enough to cover inflation. While this is generous compared to other areas of public spending, the increasing demand for care means services are under huge pressure.
"The NHS has responded well to these challenges, but financial pressures are growing, with more than a quarter of hospitals reporting deficits in 2013-14, and many more set to follow suit this year. Meanwhile, cuts in funding have led to a reduction of more than a quarter in the number of people who receive publicly funded social care.
"Unless significant additional funding is found patients will bear the cost as staff numbers are cut, waiting times rise and quality of care deteriorates.
"Some emergency support will be needed for otherwise sound NHS organisations that are in financial crisis as a result of the unprecedented pressures on their budgets."
It proposed that the next government established a ring-fenced health and social care transformation fund – of up to £3bn – to be used to develop new community-based services and to cover double-running costs during the transition between old and new models of care.
The idea is attracting some Labour health thinkers. But some Labour strategists are also concerned that politicians' pledges are simply discounted.
The alternative being discussed is to claim that reform of the NHS, including integration of health and social care, as well as reversal of "government privatisation", will release sufficient funds.
However, a commission for the influential Kings Fund thinktank concluded that while integration of social care and health was necessary, it was unlikely to create large-scale savings.
Polling this week by Ipsos/Mori found that health was the third most important issue facing voters, sitting at only two points behind the economy, which topped the list, with asylum and immigration coming second. Labour has a huge lead over the Tories on health, and it is the issue which forms its dominant lead.
The Guardian reported this week that the NHS was facing a mounting financial crisis with more than half of all hospitals now in deficit and the service likely to end the year almost £1bn in the red.
Separately on Tuesday, David Prior, head of the NHS regulator, the Care Quality Commission, warned that treatment provided by hospitals and GPs was so "dangerously" variable that poor care killed up to 10,000 patients a year.
In an election briefing issued on Tuesday the Kings Fund warned: "The next government will arrive in office with the NHS facing financial meltdown and social care in crisis."
Ed Balls, the shadow chancellor, has already ruled out earmarking a 1p increase in national insurance contributions to help fund the NHS, saying people felt they were already paying too much tax. He has also ruled out an inheritance tax to pay for an integrated health and social care service.
But other sources for temporary funding have not been ruled out, including a "sin tax" on public health polluters. Revenue from tobacco duty in 2011-12 was £9.55bn, up from £8.09bn in 2007-08. The equivalent figures for alcohol duty were £10.04bn and £8.3bn. The Treasury estimates that these taxes each represent 9-10% of NHS spending for those years.
More sin taxes, or a windfall tax, has been proposed by the former Labour health minister Lord Warner, who has suggested that a range of such taxes could reach £25bn by the end of the decade.
New research for Progress magazine, the centre-left Labour journal, prepared by Peter Kellner, the YouGov president, and given to the Guardian shows voters are evenly split on whether they would like to see income tax rise to fund the health service.
YouGov tested four areas of government spending and asked people whether, all else being equal, they would prefer income tax to increase so that more money could be spent, or see income tax fall with less spent, or keep the present balance.
The status quo was the most popular option for three of the four areas: welfare benefits for poor families, state schools, and (more narrowly) state pensions and social care for the elderly.
Only with the NHS did a majority opt for higher tax – though only by a three-point margin ("higher tax/more spending" had 42%; "keep the present balance" had 39%).
The poll also showed that higher tax for spending on the NHS was only a popular option with Labour voters, with 60% supporting the proposal. Only 29% of Conservative voters backed the idea. There have been other polls, including one by ComRes in the summer that found that 49% of people were prepared to pay more tax to help fund the health service, though one in three (33%) of people said they would not be ready to do so, and 18% did not know either way.
By contrast, a more recent Populus poll for Reform, the centre-right thinktank, found that only 33% were willing to pay higher income tax to fund more spending on the NHS, with 67% of voters saying no. A large majority thought the NHS needed reform, not more money.
The danger for Labour of going into the election highlighting the NHS without a funding pledge was pointed out by the Kings Fund.
It said: "The NHS is going through the biggest financial squeeze in its history. Since 2010 its budget has effectively been frozen, increasing by just enough to cover inflation. While this is generous compared to other areas of public spending, the increasing demand for care means services are under huge pressure.
"The NHS has responded well to these challenges, but financial pressures are growing, with more than a quarter of hospitals reporting deficits in 2013-14, and many more set to follow suit this year. Meanwhile, cuts in funding have led to a reduction of more than a quarter in the number of people who receive publicly funded social care.
"Unless significant additional funding is found patients will bear the cost as staff numbers are cut, waiting times rise and quality of care deteriorates.
"Some emergency support will be needed for otherwise sound NHS organisations that are in financial crisis as a result of the unprecedented pressures on their budgets."
It proposed that the next government established a ring-fenced health and social care transformation fund – of up to £3bn – to be used to develop new community-based services and to cover double-running costs during the transition between old and new models of care.
The idea is attracting some Labour health thinkers. But some Labour strategists are also concerned that politicians' pledges are simply discounted.
