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.’