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Independents' Day

Patients must learn the cost of care

Those who increase their burden on the NHS through their lifestyle choices must share the cost, argues Dr Phillip Lee

Future healthcare services may be at risk if we stand back and do nothing.

Younger generations are in danger of no longer having access to a health service free at the point of use, the same health service which older generations have had the opportunity to take for granted for so long. Changing demographics, rising obesity levels and increased treatment costs are a significant constraint on the current NHS.

Healthcare costs, driven upwards by an inexorable increase in patient demand, have reached a tipping point. Politicians who think the current NHS funding model can be sustained in the medium to longer term under that onslaught are deluding themselves.

The reality of healthcare demand in Britain today has changed and will be changing even further in the next decade. This is why it is time to take action to save the future of our health service before it is too late.

Governments of all colours have been avoiding any key decisions involving the long-term future of our country. We cannot continue to rule day by day, in a risk-averse fashion, and we need to be more honest about how we will deal with this challenge in the future.

We must ensure there is a long-term vision for our health service – on the current trajectory, public sector spending will eventually account for well over 50% of GDP and that is simply not sustainable.

If we dismissively continue to increase debt beyond the £1 trillion it is currently at, and if we continue to raid public-sector pension pots beyond the £300 billion we already have, there will be dark consequences at the end of the road. I suggest that 85% of NHS expenditure should continue to be funded by the state, but the remaining 15% should be taken on by individuals incrementally – a meagre £15 billion out of the total £400 billion welfare budget. Is that really too radical to contemplate?

I care about my country and its people and that is why I am emphasising the need to focus on the demand side of healthcare provision.

Lifestyle choices

In these challenging times, healthcare responsibilities should be shifted from the state to the individual, to reflect people’s choices of lifestyle.

No doubt changing the public’s mindset on this issue will be an extremely arduous political process with no short-term reward, but we have no choice. For those of us who want to protect the fundamental principle of access to all, we need to start engaging the British public in this difficult debate now. People need to realise the cost implications of their lifestyle choices.

I want people to be free to choose any lifestyle they wish at the same time as understanding the implications of such a choice.

I want to give more to the truly deserving because we are spending less on those who are perfectly able to provide for themselves.

If we do not act now, then the truly vulnerable will be at risk. Consequently, I believe moving the responsibility for drug costs away from the state to the individual would allow the individual to attach such a sense of responsibility.

Earlier in the year, I argued in a Ten Minute Rule motion in the House of Commons for a bill that would require GPs to issue annual statements on healthcare costs. The bill would require GPs to issue annually, to each person eligible for care provided by the NHS, an itemised account of the cost of his or her healthcare. The bill was rejected in Parliament: a clear demonstration of how little people understand the increasing burden the NHS is facing.

As a medical professional, I have seen over 50,000 patients, and it has been striking to see the stark difference in attitude between the generations. The stoical, post-war attitude appears significantly different to that of younger generations.

When baby-boomers hit their eighties after 2025, around 25% of the NHS budget will then be being spent on diabetes alone.

Without doubt, an increasing number of people are getting prescription medication for conditions predominantly to do with lifestyle choices.

Clearly, I am not saying that all do, but to ensure that the chronic and terminally ill patients of the future have the care that they will need, we need to make some tough decisions about future funding now.

Dr Phillip Lee is the Conservative MP for Bracknell and a practising locum GP

Readers' comments (6)

  • Who are the 'we' constantly referred to......the NHS belongs to all citizens of the UK including 'them' and others newly arrived who qualify .

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  • I have to admit-you have "cohones".....I don't have the balls to take on a patient never mind The Patients Association. You will probably be eaten alive for challenging "Tax Payers".

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  • I am a fat person and a diabetic on insulin, my heart is clapped and my kidneys are in 1st stage of turning to mush. I did work for the NHS for 30+ years in a quasi senior nursing position. I ate , drank and smoked and will soon meet my redeemer

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  • While I agree that individuals need to be empowered to take responsibility for their health this is not the way to do it. Firstly there are practical problems - if an individual has a stroke how do we know whether it's due to lifestyle risk factors or bad luck? Secondly where would it end? What about people who break their leg skiing? Or people who go for a walk on a cold day and fall over on the ice? We all take risks of one sort or another - which ones are we going to charge for?

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  • a large proportion of those abusing the NHS are not contributing through taxes! They waste their charity payments (oops, I mean benefits) on alcohol, cigarettes, bad food, TVs etc.....oh, and the drug addicts, well, I hear they can afford to arrive at the Job Centre in taxis!

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  • As an MP, do you have any say about reforms in the NHS? How about introducing a policy whereby OTC medications are not prescripbable any more? I had a patient in who did not see why she should pay 99p for an OTC vitamin because she could have it for free!

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