In an important but largely unreported debate in the House of Lords on 9th July, Lord Prior, the government health minister proposed a move away from a tax funded NHS towards private insurance and co-payments. He suggested an inquiry be set up chaired by a panel of experts to look at this question. The proposal came on top of both Tory and Labour discussions about widening the funding model beyond a purely tax funded one. This is a potentially significant development and the first clear signal –coming so soon after the election – that the government is considering a move away from the founding principle of the NHS as a tax funded service based on need, not ability to pay.
Charging for services will shift costs to those who use the system most: sick people who tend to be the poor and the elderly.
Research shows that user fees encourages people to forego necessary medical treatment to help manage chronic diseases, resulting in more visits to emergency departments and an increase in serious adverse events. Related research found that although it is not certain that user fees lead to negative outcomes for all patients, their effect on the chronically ill was clear: increased emergency department use and hospitalizations.
These proposals come as part of intense pressure on the NHS to find efficiency savings of £22 billion pounds
While the government is giving the NHS an extra £8 billion, this money is based on the assumption that an extra £22 billion pounds can be found in efficiency savings. Such savings now appears to be an impossible target and senior figures at NHS England have told the Observer they expect the service to fall well short of its £22bn target by the year 2020, and that it will therefore need a further £7bn injection from the Treasury, on top of the £8bn, in order to maintain standards of care – £15bn in all.
This is backed by the financial think tank CIPFA who go further and point out that even if such efficiency savings were achievable, they would not cover the added resources needed to meet the government’s election commitments to seven-day GP services, same-day appointments for over-75s, and training 5,000 more GPs by 2020 .