Tories and the tricky case of charges in the NHS

So there you have it: the gloves are finally off

Sajid Javid has come out openly and said what I’m sure some of his fellow Conservative party members are thinking. Namely, it’s about time people in Britain started paying to see a GP, or to attend Accident and Emergency[i].

The former health secretary’s proposal to charge ￡20 for a GP consultation and ￡66 for attending Accident and Emergency, finds its basis in similar plans already in place in Ireland and Norway. Such a plan would, he claims, help with waiting lists in the NHS. Besides, ‘extending the contributory principle’ is apparently part of the ‘grown-up, hard-headed conversation’ he’d like to have about reforming national healthcare. After all, in his opinion, ‘too often the appreciation for the NHS has become a religious fervour and a barrier to reform’.[ii]

The thing is, he’s not entirely wrong.

There does need to be a sensible conversation about how the NHS moves forward. Chronically underfunded and understaffed, at the moment it is on the brink of disaster and something needs to be done about it. But charging for access?

No.

But look what’s happening!

The situation in the NHS hasn’t appeared overnight. The pandemic exacerbated the healthcare systems multitude of problems, but it came on the back of a decade of underfunding[iii]. It shouldn’t be a surprise now that there is a crumbling infrastructure (both in terms of healthcare provision and physical equipment and buildings).[iv]?But introducing a payment plan isn’t the solution to this issue.

The government has been quietly selling off bits and pieces of the NHS for a while now. It’s not a new move.[v]?The problem is, the process is no longer enough – the financial cracks are widening and the problem is much, much bigger.

So what’s the problem with introducing charges?

Quite frankly, the idea faces a multitude of problems.

The concept of paying upfront fees to access the NHS isn’t a particularly new one.[vi]?Back in 2013, Jeremy Hunt (then health secretary) floated the idea of cracking down on ‘health tourism’. The plan was to introduce a system that enforced payments for healthcare provided to non-EU migrants. It was, technically, a good concept. Except for the fact that introducing a system to enforce these fees, would ultimately have ended up costing the NHS more than it would have recouped.[vii]

The same would be true of Javid’s fee-paying system. You would need to hire more administrators. Managers. Debt collectors and finance officers. Javid’s dream of building an infrastructure in the NHS that is able to start eating away at the financial problems the institution faces, doesn’t seem to be taking into account the massive amount of expenditure it’s going to annually take to keep that infrastructure running in the first place.

It's also going to cause problems with patient access, and for me this is the biggest issue.

Javid’s proposal is that the system should be means-tested. Again, this is great in theory – but look how slow the benefits systems already are in the UK. When you need to be seen for urgent care, you need to be seen immediately. Not in two weeks, when it’s finally been agreed by a means-tested system that no, you don’t have to pay that ￡66 fee after all.

And besides, the cost-of-living crisis is mounting. People are already struggling financially. If it comes down to a choice between paying ￡20 to see your GP for a problem that might go away, or eating that week? People are going to choose eating. A fee might deter people from time wasting, yes. But far more worryingly, it’s actively encouraging people to kick any potential health issues further down the road.[viii]?If this happens, treatable conditions might become far worse, costing both patient health and causing additional medical intervention, resulting in higher financial pressure anyway.[ix]

Fee-paying to access frontline healthcare is a dangerous pathway to a two-tier system. It’s one that relies on those who can afford to pay being able to access it, and those that can’t being unable to. It’s not privatisation – not quite – but it’s the start of valuing finance over peoples’ lives, and it’s not something I’m happy with.

And lastly, I’d like to remind everyone that in the UK we already pay for our healthcare system. All of us. It comes from our taxes and our National Insurance.?

Am I happy to pay this??

Absolutely.?

Would I gladly pay more, to ensure nobody ever had to face the choice between their long-term health or their short-term living??

Without question.

In short…

The UK government says it’s not ‘currently’ considering Javid’s proposed measures. But given the Prime Minister’s leadership campaign promise (later dropped) to start fining those who miss healthcare appointments, I’m worried it’s only a matter of time before one of these proposals sticks.

Because, you see, the NHS is based on some fundamental principles:

·???????To provide a comprehensive service, available to all

·???????Access to NHS services is based on clinical need, not an individual’s ability to pay

·???????To put the patients at the heart of everything it does[x]

Those principles are everything. They mean every single person is entitled to treatment. Every person – irrespective of their financial position – can access the same level of treatment. I am viciously proud of them. I will defend them with every fibre of my angry being.

The NHS principles are at the heart of what we do. It’s an institution that – for all its faults – I am extremely proud of. And so to me, proposals to introduce fees is something that should be anathema to anyone who values health and life over money.

So no, Sajid Javid, I won’t have a ‘grown-up conversation’ about reforming healthcare and introducing charges.?

Not when the actual, dangerous, cost to the UK public and the NHS would be so much more.

[i]?Wingate, S.,?Sajid Javid: patients should be charged for GP and A&E visits to ease waiting list, 25.01.23

[ii]?Wingate, S.,?Sajid Javid: patients should be charged for GP and A&E visits to ease waiting list, 25.01.23

[iii]?BMA,?Health funding data analysis, 26.01.23

[iv]?King’s Fund,?The NHS budget and how it has changed, 08.12.22

[v]?Fisher, A.,?The NHS is being privatised by stealth under the cover of a pandemic, 03.05.21

[vi]?Campbell, D.,?Basic NHS services could be charged for after general election, BMA chief says, 03.04.15

[vii]?Eaton, G.,?Why Hunt’s crackdown on ‘health tourism’ could cost more than it saves, 03.07.13

[viii]?Hayre, J.,?Charging for GP visits defies all the rules of healthcare economics, 27.01.23

[ix]?Welch, E.,?If Sajid Javid thinks charging patients will help us, he’s wrong, 24.01.23

[x]?NHS,?The NHS Values, 26.01.23