Health chief suggests NHS may have to charge patients

By Sarah Neville

Comments to the FT from one of the most important figures in the NHS this morning ask the most fundamental question that can be asked about the NHS: in an era of austerity can a universal free health service survive?

Malcolm Grant, chairman of NHS England, told us that he thinks a future government will have to consider more widespread user charges in the health service unless the economy picks up.

Grant made clear that he would not support any departure from the defining principle of a free-at-the-point-of-use NHS. But that doesn’t matter – these are macro-economic decisions for government that fall beyond his remit.

There is scarcely an intelligent observer of the health service or the economy who would not agree that, short of miraculous economic recovery, this is a debate that is now unavoidable.

The Institute for Fiscal Studies and the Nuffield Trust jointly warned last year that the range of free services might have to be reviewed as the NHS faced a “decade of austerity” until 2021.

But it is also a highly politically-charged debate. Jamie Reed, the shadow health minister, said today:

It has come to something when the new NHS chief warns the government’s economic failures could leave NHS patients paying for treatment from their own pocket.

Patients are already finding important treatments like cataract operations and hip replacements are being rationed to cut costs. Too many are facing agonising decisions over whether to pay privately or go without. David Cameron’s economic mismanagement must not force a cash-strapped NHS to start charging its own patients.

Would the general public wear it? Focus groups conducted by Ipsos MORI for the King’s Fund, which we also report today, suggest that instinctive resistance softens once the economic realities are explained.

Commitment to the founding principles of the NHS remains absolute but the panel members nevertheless were willing to contemplate charges for “discretionary” services such as GP walk-in centres.

People who had been seen to bring their conditions on themselves through unhealthy lifestyle choices should also be expected to pay a contribution, some participants argued.

As other ministers grow restive in the run-up to the June spending round at the decision, yet again, to protect the health budget, these arguments may sound ever louder in Whitehall and beyond.