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NHS should consider charging patients for home visits, says NHS Confederation

The NHS should consider charging patients for home visits or hospital meals in a bid to deal with the intense financial pressures the health service faces due to an ageing population, according to a controversial discussion document drawn up by NHS managers.

The paper Tough Times, Tough Choices, released today by the NHS Confederation, which represents trusts across the NHS, presents a series of ‘radical’ options for the future of the health service.

It suggests the NHS could raise private income by introducing new charges, although it acknowledges that income would be limited and the idea would be politically fraught.

The paper presents a case study from Germany, where in 2004 a charge of ten Euros was introduced for each physician or dentist visit in a three-month period. The charge was applicable to those aged 18 and covered by statutory health insurance - around 90% of the population. Surveys found that 45% of patients delayed or avoided physicians’ visits in light of the charge.

The report said: ‘If increasing public spending on health is problematic, some governments may look to raise extra revenues from private spending. The most likely source for this would be to increase the user charges that are currently applied.’

‘Other health systems have introduced user charges that go beyond those currently employed in the NHS - for example, user charges for physician visits in France and Germany.’

‘Such charges in the NHS might have the same limitations as prescription charges, where patients may be deterred from accessing health services.’

Introducing charges for hospital food or television was also suggested, although the report said the amount that might be raised was ‘probably not significant’ and that politicians’ commitment to keep the NHS free at the point of usage would make it difficult for them to introduce such charges.

The report also criticised the burdensome impact of smoking, excessive drinking and obesity on the NHS. It said up to £17.9 billion a year - almost a fifth of the health service’s budget - was spent on people living with associated diseases and conditions.

Further expenses, such as a rise in staff costs due to salary growth and the cost of financing initiatives such as PFI schemes - likely to double over the next 17 years - will sharpen financial pressures on the NHS, it added.

NHS Conferderation chief executive Mike Farrar said: ‘The NHS is facing severe pressure on its finances. We are coming to a critical juncture and need to have a frank discussion about the road ahead. This is a crucial time to show our commitment to improving the way we work and how we involve the public in decisions about their care.’

‘The simple truth is that we have been slow to change the NHS into a truly modern and efficient service. In the past the easier options have been to spend more money on health or to focus on doing more for less.’

‘We need to talk openly and honestly with the public about why our health services need to change, presenting all the facts.’

Readers' comments (6)

  • The NHS Confederation is not recommending the introduction or extension of user charges for GP visits or in-hospital services, such as food and television. The Tough Times, Tough Choices report focuses on having an open and honest discussion with the public about the merits and flaw of the choices that might be considered in response to an increasingly challenging financial environment.

    The report makes clear that some governments might consider the extension or introduction of user charges as part of a "spend more" scenario and highlights the limitations of this strategy, not least the potential to restrict access for people that might need but are unable to afford services.

    Paul Healy, NHS Confederation

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  • But you cannot have a honest debate by defining it the way that you have. In particular if you get the economics wrong then the rest falls with it.

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  • Surely prior to charging for visits, patients should be asked to pay nominal fees for multiple DNA's and uncessary A&E attendances? I for one do believe that if/when a nominal fee is introduced for GP consultations, this will improve the quality of the consultation for both patients and those caring for them. Interesting times ahead.

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  • NHS dentists charge for an appointment! My patients who genuinely struggle to get an appointment are frustrated that other patients DNA, many as repeat offenders, with no penalty. Many of my appointments are taken up by minor illness, because the receptionists just put patients in for convenience. Having a nominal £10 appt fee would dissuade the majority from booking an appointment as soon as they have a sniffle. Equally, the number of people that waste GP appointments because they don't pay for prescriptions and want anything they can get on prescription (ie free of charge), often when it is available over the counter and for pennies.....the cost to the NHS of the GP appointment, pharmacy charges etc clearly outweighs the cost of the medication that could have been bought.
    We've allowed a selfish, consumeristic, complaining society to abuse the NHS and its staff.
    Interesting, that other NHS/medical staff are so respectful in general of the work we do, but lay people behave as if medicine and its professionals are a commodity market.
    Time somebody made some sensible decisions to clear this mess up and stop pandering to the political issues ie voting numbers.
    For all the repeated changes trying to reduce spending, until a stop is made to the abuse we deal with, there is no chance for the NHS, and how many of us will retire or leave?!

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  • A small fee, absolutely. Reduce unnecessary demand. Patients pay by waiting for months or years on long waiting lists. No free lunch

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  • Nominal fees devalue the professional. Most problems are caused by half baked solutions. Either pay for the appointment at full price or not at all.
    There is already a sense of entitlement- 'I pay my taxes' if an appointment becomes a business transaction that 'entitlement' will be enhanced. There will also be the accusation about money making rather than care.

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