A cure for the NHS cold?

In November the think tank “Reform” produced a report which advocates the introduction of new charges for access to the NHS and reform of some existing ones. The premise is twofold. First that, even with the Government’s commitment not to cut NHS spending, heath inflation is such that additional funding of £30 billion will be needed by the end of the decade. This is not Reform’s figure – it is the Government’s own calculation. Secondly, it can be argued that the NHS is overly dependent on taxation. Indeed, Simon Stevens, the incoming Chief Executive of NHS England has commented that, “partly because of the NHS’ tax-funding mechanism… whenever the post-War British economy sneezes, the NHS catches a cold”.

The report suggests several potential changes to the current set up. An increase in the level of the charge for prescriptions from £7.85 to £10.00, and in the cost of a Prescription Prepayment Certificate from £104 to £120. Reducing exemptions for elderly people and pregnant women so as to double the number of charged prescriptions from 10 to 20 per cent. An alternative could be to move to a French-style system, with exemptions for only 20 per cent of drugs dispensed and a lower charge of £3.00.

Beyond prescriptions, charges could be introduced for secondary and primary care. This could involve a charge of say £10 for each visit to a GP, £10 for a missed appointment (for GP or hospital services), and a daily “hotel” cost charge for in-patient care. They argue that all these charges could make a significant impact on the £30 billion challenge.

In other countries, the debate on such charging systems has mainly been about equity of access for those on low incomes, the administrative cost of collecting the money and the potential to deter patients from preventative care. Public opposition to change is also likely. Germany, for example, introduced a charge for GP appointments in 2004 but withdrew it in 2013. And there has been a similar debate in Ireland. Over here, there will be an additional issue – that such an extension of the current charging system undermines the principles of the NHS. Will any political party have the will to tackle this?

In another part of the forest, the Bruce Keogh’s review of hospital services advocates moves in two directions: to more provision at primary care level and for fewer better more centralised centres of excellence for hospital services. The effect of this would be that patients (and their families who wish to be with them) would need to travel longer distances to hospital and may well incur hotel costs for their relatives. Again will any party have the will to take this on – even though it will clearly save many lives? It seems almost everyone campaigns to save their local hospital even if it is killing people.

Well, let’s suspend disbelief for a minute and image that there is the political will to address both of these reports. The effect would be that patients and their families would still get “free” care under the NHS but they would end up paying significant extra costs for their prescriptions, visits to GPs and to hospital. How would they meet these costs? I suggest they would meet them through cash plans. The set up in Ireland is not a million miles away from what is advocated by Reform and there is both a big cash plan market and also a bigger PMI market (which covers private treatment as well as the cash plan element). However in Ireland there is tax relief for PMI.

Written by Richard Walsh – first published in Cover magazine, 12th December 2013. (click here for Cover article )

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