An independent UK think tank has suggested people should pay £20 to see their GP, as a way to relieve the financial squeeze facing the National Health Service.
The Social Market Foundation, described in some media as a right of centre think tank, is releasing today a new report titled “From feast to famine: reforming the NHS for an age of austerity”, that details the results of two years research into the long term future of the health service in terms of demographic, technological and economic change. The authors are Barney Gough and David Furness.
The authors suggest that the NHS will have to change dramatically to make it through the economic downturn, and meet serious challenges in years to come. The NHS will have to become more efficient and change its approach to what is fair, they said.
The report sees only three options for the NHS: raise more money, make better use of existing resources, or slow demand for healthcare. There is no political appetite for raising more money since this means putting up taxes, so the only viable options are to become more efficient and slow demand, said the authors.
They recommend charging for services as a way to make people prioritize and think about how to ration their use of “precious health resources”, not as a way to raise revenue (the amount that would be needed for the latter would be out of the reach of most people anyway and destroy the NHS as we know it, they said).
Other European countries already levy a modest fee for use of healthcare resources, and if this is set at a reasonable amount it does not necessarily undermine the idea of fairness to make sure equal access for equal need, suggests the report which also proposes the NHS charging system be reformed to reflect income and not categories such as pregnancy or retirement.
Not everyone would have to pay under the recommendations set out in the report: for example, anyone in receipt of tax credits, which includes around the 30 per cent poorest people in society, would be completely exempt from NHS prescription charges.
People in receipt of tax credits would also be exempt from paying the suggested £20 fee for visiting a GP, the idea being to encourage healthier and wealthier people to avoid using the NHS except when absolutely necessary.
The charges for GP appointments and prescriptions should however be capped, said the authors, who proposed a ceiling of around £100 a year.
Furness said:
“The core principle of the NHS should be that it is fair.”
“But fair is not the same as free at the point of use,” he explained, adding that “free care for all will end up making the NHS less fair.”
He and co-author Gough maintain that charging (with the above named exemptions) is preferrable to what they describe as “rationing by stealth via waiting lists, crumbling hospitals and poor quality services” which hits the poorest members of society much harder.
To encourage efficiency improvements, Gough and Furness recommend replacing national targets and standards with a model based on local provision policed by high standards commissioners. This will eliminate the “postcode lottery” system and replace it with one that reflects the benefits of local choice, they said.
The authors recommend the reduction of central control and putting in place local commissioners who can identify efficiencies and improve performance of healthcare providers.
The status and authority of commissioners and therefore the quality of healthcare providers, should be underpinned by the creation of a “Royal College of Commissioners”, and giving them higher powers and responsibilities.
They also recommend that GPs and consultants have local contracts, and public petitions be used as a way to demand reviews of commissioner performance.
Gough said:
“Some difficult decisions will have to be made and the public won’t accept these if they seem to be driven by central government.”
“Central government will not be able to drive the efficiency savings the NHS needs to survive,” he added, explaining that instead, “responsibility must be given to autonomous local commissioners to work with local people to design a range of services appropriate to their needs”.
The report makes a number of other recommendations, including the appointment of a new Cabinet Minister for Health Inequalities, targets for the NHS to deliver equal access for equal need, and the abolition of the Strategic Health Authority.
Source: SMF.
Written by: Catharine Paddock, PhD