Will patients be charged for NHS services?

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King’s Fund member explains why charging for healthcare should be a no go area

King’s Fund member and social policy professor Julian Le Grand has spoken out against the idea of charging for healthcare services, instead advocating a “a single pathway of care with a single ring fenced budget and a single commissioner.” 

Long opposing the ideas of charging for NHS services, Mr Le Grand not only points out that this would prove difficult for “the less well-off” but he also comments that there is a “fundamental source of inequality or unfairness from charges.” Writing in the HSJ, he emphasises that most patients become ill due to bad luck, continuing to say that “people should not be held responsible for or be made to pay for situations that arise wholly or largely from factors beyond their control.” 

Although having fees for services is frowned upon, it does raise the question of how healthcare can be made sustainable. Some ideas thrown around include charging for GP attendances, for appointment no shows and for hospital care, however these wouldn’t necessarily solve the situation. Charging for GP attendances could encourage patients to visit packed A&E departments instead, adding to the treatment delays and long queues already a regular feature at hospital entrances. Charging for no shows also proves problematic, as Mr Le Grand notes that these individuals are usually tricky to get hold of, so it would therefore be difficult to collect the debt. As well as being costly to put in place, charging for hospital care could be counter productive, discouraging people who really need care from visiting hospital.

No fees for healthcare

To combat this, Mr Le Grand and his colleagues have called for a new settlement that would better align both health and social care services, as the two have become more intertwined in recent months. Mr Le Grand explains this would feature “a progressive increase in the amount of social care free at the point of use and with the small exception of some reductions in the exemptions for prescription charges, the preservation of NHS care free at the point of use. The reason for the commission’s call for a new settlement arose from the prime purposes of any health and social care system: to promote fairness and alleviate distress and suffering.”

Mr Le Grand also comments on the importance of combining both health and social care services together, saying “Overall, the fairness case for providing most social care free at the point of use seemed just as compelling as that for healthcare: no one chooses to get Alzheimer’s or Parkinson’s.”

Where do you stand in this discussion? Do you feel charges for patients are inevitable or should be avoided at all costs?