Who said this?
“On this question of ‘principle’ of a free health service, it is nonsense… This is not a question of principle, but to the contrary, it is a practical matter”.
I think it would surprise many Labour supporters to know that this was the verdict of Tony Benn, writing in his diaries after Hugh Gaitskill’s 1951 budget that introduced a limited range of NHS charges. Benn, in contrast to the intransigent Nye Bevan, had it right about the principles of the NHS. The NHS is a tremendous symbol of our shared values. The health service rightly puts fairness at the heart of what it does. But fairness doesn’t have to mean free.
The crisis in public finances will hit health services hard. Whether or not health budgets are protected in real terms, the move from the large increases of recent years to a more modest funding settlement presents a real challenge to the NHS. The NHS chief executive has said that the health service must save some £20bn over three years.
There are three possible approaches to deal with the impact of the downturn i) raise more money ii) become more efficient and iii) manage demand for healthcare. Unfortunately the first of these is not a realistic option. More money for the NHS is unlikely to be forthcoming given limited appetite for tax rises and the rising rate of government borrowing.
Our report, “From feast to famine: reforming the NHS for an age of austerity” argues that there is substantial scope for the NHS to become more efficient. For this to happen, more responsibility should be given to autonomous local commissioners to drive the change that is needed to secure high quality healthcare in the long term. A single regulator should be established to assess commissioner quality, and new democratic mechanisms should be introduced to help local communities hold commissioners to account.
While the NHS can and will become more efficient, it is doubtful that this alone will be enough to plug the financial gap. So, managing demand for care must also be discussed. One of the most powerful mechanisms to manage demand is through charging. That is why we have recommended that the entire system of NHS charges should be overhauled. Poorer people, means tested through the tax credit system, should be offered genuinely free care. Rather than exempting pensioners and pregnant women even if they are well able to pay (think of Sir Fred Goodwin’s pension pot!), the system of NHS charges should be entirely based on income.
As well as this move towards means testing for existing charges, a £20 charge should be introduced for wealthier patients to visit the GP, with those on low incomes completely exempt. We know that for the vast majority of patients reducing their use of healthcare has no adverse effect on their health. A £20 charge would encourage wealthier people to consider how best to use the health service – perhaps visiting pharmacies or using NHS Direct rather than visiting the doctor as a first port of call. But it would not be sufficient to stop people from seeking care when it’s needed, and those who cannot afford it would not have to pay. This limited form of charging is an opportunity to curb the inexorable and unsustainable growth in demand for healthcare.
As Tony Benn reminds us, charging is a pragmatic issue, not one of principle. To make sure we have a fair health service in the future it is right to make sure that poorer people have a genuinely free service. But charging must be discussed now if we are not to return to the bad old days of long waiting lists, crumbling hospitals and a poor quality of care.
Charging for NHS services!!! Absolutely not. The principle of being free at the point of delivery is sacrosanct. I know we cite instances of people previously avoiding going to a Doctor because they couldn’t afford medical bills and how the NHS has overcome this but the principle is that the NHS is for everyone, including those who could have previoulsy afforded to pay. Charging is divisive and operates against inclusiveness which is inherently dependent on the fact that there are no solutions to poverty that will not also involve those who are not poor. The NHS is not a poor mans service; it is everyone’s service.
Given we’re being ‘sold’ the idea that times are hard and money is now in short supply [and this is by the self same people who told us that we couldn’t afford to pay more in State Retirement Pension or Child Benefit etc before they paid hundreds of billions to banks] then we should be phasing out any private use of NHS property, facilities or personnel and exlcusively reserving this for public, that is NHS patients. If schools operated in the same way as the NHS does, with some teachers leaving state pupils to walk off to the other end of the school to teach classes of about five private sector pupils in a state financed, there would be riots on estates all over the country. Nothing against private health care but for the fact it feeds off the NHS. When did private health invest in training nurses or doctors? They can have their private hospitals just as they have their private schools, but don’t take up public funding to do it. Keep it completely separate.
Yes, we need to review the care and treatment the NHS provides free at the point of need but starting from the need to raise money without taxation is not constructive.
There is a huge problem with means testing in this way. How low an income would be needed to qualify, how much paperwork (and administration) and would family circumstances be taken into account?
For single people on relatively high incomes or the few on very high salaries, £20 may not matter. For most families, including those on £30 – £50K, it certainly does. Yet they would be the people stumping up for this.
This sounds like a policy discussion out of touch with the real world. This is not a world simply divided into ‘the poor’ and ‘the rest’ who can afford any and every new charge that comes their way.
Where is your idealism, SMF? When Obama is trying to bring in free healthcare in the USA, you would drag the UK back into a pre-Atlee dark age. No, no- one should suffer a financial detriment to visit the doctor.
Since Pensioners have more healthcare needs as they age and the neglect of earlier stage morbidity can lead to more expensive and protracted treatment later, any Pensioner discouraged from attending the GP because of thrift could result in more health inequalities.
Women might sacrifice their own heathcare to spare the cost for the family, just as many women already stop saving for pensions when they have children.
The introduction of charges to see a GP would be retrograde, inhumane, socially divisive and inevitably impact disproportionately on disadvantaged socio-economic groups in a way which the imperfect and bureaucratic tool of means-testing would not adequately address ( cf the perennial struggle to reach Pensioners who should be claiming means-tested Pension Credit).
Universal and free at the point of delivery, the NHS Primary Care paradigm is held up as a model of fairness and clarity compared to the piecemeal localism and uncertainty of charging in the provision of social care.
Better to reverse the Thatcherite introduction of charges for dentistry and eyetests, which were firmly opposed by an enlightened House of Lords in the early 90’s. And, at the same time, axe prescription charges too and pay for all healthcare through progressive taxation.