NHS funding: will patients be forced to pay for some care?
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Version 0 of 1. With NHS providers on track to run up deficits in the region of £2bn this year, the spectre of patients paying for more services again looms over the NHS. Last year’s combined deficit of £822m across the provider sector hid an even more serious truth: add in the extra £250m from the Treasury and another £650m transferred from capital budgets and the underlying deficit was nearer £1.7bn. With little prospect of finding the required £22bn of efficiencies, and the Health Foundation and King’s Fund pressing for even more money on top of the additional £8bn already promised by the chancellor, George Osborne, one way or another we are going to have to find other ways to pay. We can thank the Germans for all but killing off one idea that used to be touted – paying to see your GP. In 2004 Germany introduced a €10 quarterly payment but the Bundestag unanimously scrapped it eight years later. Predictably, the cost of administration almost outweighed the money collected, and there is some evidence that it deterred people on low incomes from seeing their doctor. The strongest argument against charging to see a GP here is that it would destroy the best thing about the NHS – that it is free at the point of need. But there are other ways the edges of that principle could be blurred. Related: NHS finances: how will we plug the £22bn gap? The room for manoeuvre comes at the intersection of three healthcare trends – integration of health and social care budgets, greater use of personal health budgets, and the shift of care from hospitals to homes. Eight areas, such as Barnsley and Luton, are in the first wave of the integrated personal commissioning programme, leading the way towards integrated health and social care personal budgets. Personal budgets in social care have demonstrated their power to build services round the client, give people more control over their lives and save money. Their use for NHS services has huge potential to drive new care pathways while reducing emergency admissions and keeping patients at home. But care at home also provides room to start charging for services at the boundary between health and social care. A more radical plan, with the Dilnot reforms aimed at capping care costs now stalled following the government’s postponement of the promised changes, would be for ministers to rethink the whole proposal and look at compulsory insurance for social care, similar to that introduced in Japan. Labour leadership candidate Andy Burnham has tentatively backed the idea. Related: Who has the answer to the £22bn NHS funding question? While government proposals for anything that smacked of a new tax would face substantial opposition from its backbenchers, the haemorrhaging of money from social care itself carries big political risks. How long before nursing homes are hit by their own Winterbourne View-type scandal? And the “national living wage” plan seriously exacerbates the funding pressures. A less politically toxic alternative would be for Jeremy Hunt to reverse his previous opposition to a tax on sugary drinks. Last year Mexico – which has one of the highest obesity rates in the world – became the first country to impose such a tax, and in May the life sciences minister, George Freeman, became the first member of the government to back a tax on sugar. Public Health England is looking at the issue. With rotten teeth being the most common reason for young children to be admitted to hospital, a sugar tax could cut demand for NHS services quickly as well as provide potential revenue. With a radical chancellor winning plaudits for bold moves, perhaps a sugar tax could be seen in the same context as the increase in the minimum wage announced in the emergency budget; bringing about change by shifting costs away from government. Something has to give. The present financial targets are a fantasy. Either through taxes or charges we will have to pay more in this parliament. |