Columnist Dr David Turner argues that if we want the NHS to survive, then we should consider charging those who can to pay for some of their healthcare
Earlier this year, former health secretary Sajid Javid said that charging for GP appointments and A&E visits is ‘crucial’ for the survival of the health service.
This is by no means a new suggestion, and it is usually met with a barrage of resistance. The mere suggestion that anyone should have to hand over even the most trivial sum of money for an NHS service seems to bring out the socialist in even the most hard-line right winger.
The NHS is seen by many as the great equaliser in society. You already know the argument: that anyone, rich or poor, can become ill at any point in their lives and may need the services of a tax-payer-funded healthcare service. And that’s all well and good, only the argument is far from being that simple.
Name pretty much any disease or medical condition you like and you will find it is more prevalent among the poorest in society. The reasons for this are complex, but certainly substandard housing, polluted air, poor educational opportunities, lack of access to affordable healthy food and inadequate recreation facilities are some of the reasons the least well off are more likely to get ill to start with.
I suspect that few people in the UK would support a policy of state control over house and food prices to make the possibility of better accommodation and an improved diet more available to those on the lowest incomes. Yet, arguably, it would be money better spent: stopping people becoming ill, before they need the services of a state-funded health service.
Whether you agree with Mr Javid or not, it is an inescapable fact that the health service has to change. We are not living in 1948, and despite recent problems with inflation, most people are immeasurably better off than they were in the post-war years. Even middle-level earners, who would not consider themselves rich, take two or three holidays a year and update their car regularly. If we want to keep the NHS going for the genuinely poor, then maybe we should ask the richer in society to take one holiday fewer and postpone the new car purchase for a few years and use the money to pay for some of their healthcare.
We also must consider that the private sector is not going away. It continues to snap at the heels of the NHS, chewing off the easy-win chunks of healthcare. Instead of seeing the private sector as the enemy like many die-hard NHS stalwarts, how about we work with it to help unburden the NHS? If the richer in society can afford to pay for some of their care privately, then why shouldn’t they?
Many will argue this is not fair. And no, it isn’t. Life isn’t fair. It also isn’t fair that some of these people live in vast houses and send their children to be hot-housed in private schools. But unless we suggest their houses should be repossessed and repurposed for communal living, and their private schools closed down, we are not really being consistent with the ‘equality’ model of the NHS.
Now, don’t get me wrong, I would love to live in a more equal society. But I think this is unlikely to happen any time soon. Having worked on the NHS frontline for more than two decades, I have seen first hand the abuse and waste that is caused by some of the end-users of the service. Perhaps a small charge to those who can afford it may make people value the service they have a little more.
Some argue that charging for NHS services will delay the presentation of serious conditions. But where is the evidence for this? As Mr Javid points out in an article in the Times, lots of wealthy countries, including Norway and Sweden, charge patients to see the GP, and I don’t think their health outcomes are worse than ours. In fact, they are generally a lot better.
It is time to take off our blinkers, and think broad and wide. No idea can be off the table if we want the NHS to survive, in some form at least, for another 75 years.
Dr David Turner is a GP in Hertfordshire. Read more of his blogs here