Private health firm gives GPs operation price list for impatient patients (The Guardian, 5 December 2017)

A private healthcare company has sent letters to hundreds of GPs setting out a price list of operations they could offer their patients to beat NHS delays and restrictions.

Care UK, which runs nine centres offering treatment on the NHS, said it intended to use spare theatre time to provide “self pay” procedures ranging from earwax removal to hip replacements.

The company said it was trialling the scheme at two treatment centres in the west of England but insisted core work at the sites would remain NHS referrals.

The move has, however, alarmed some GPs and health campaigners who fear it is another example of creeping privatisation in the NHS.

The procedures are being offered at the Emersons Green treatment centre near Bristol and a second centre in Devizes in Wiltshire. The list of treatments on offer ranges from earwax removal (£160) to hip replacements at just under £9,000. Other procedures being offered include cataract surgery, tonsillectomies and vasectomies. more

NHS trust sent cancer patient adverts for private clinic (The Guardian: 5 August 2017)

A terminally ill cancer patient has protested after the NHS hospital where she receives palliative therapy included advertisements for a private clinic with her appointment letter.

Ali Schofield, 33, who has secondary breast cancer, said the inclusion of the leaflets for Nova Healthcare was “disgusting” and “distressing”. It would make patients believe that NHS care was “second class” and they should pay for private treatment.

“I felt really cold when I saw the leaflet because it suggested that I would have better healthcare if I was to go private,” she said. “It offered me access to the latest technologies and made me think: so what am I getting now? It’s disgusting. It puts the seed of doubt into you.”

Schofield, a lifestyle journalist and collage artist, said she was appalled that the NHS had used her medical records to include promotional material for a private company. She also criticised the fact that posters for Nova have been put on the walls of the oncology unit at St James’s University Hospital in Leeds where she goes for her chemotherapy.

Nova, which has a contract with NHS England to provide specialist “gamma knife” radiotherapy, uses the fourth floor of the Bexley Wing at St James’s to offer consultations and daycare for private patients, while NHS patients including Schofield receive their treatment on the first floor.... read more


Charges proposed for out-of-hours GP appointments in England (The Guardian : 25 January 2017)

Patients could face paying their family doctors for out-of-hours appointments and minor procedures that fall outside the surgery’s contracted NHS work, under new plans being proposed by some GP leaders.

The scheme would see doctors use their own time to treat and charge patients and involve the setting up of a third-party company to manage the payments to GPs.

Dr Prit Buttar, leader of Oxfordshire’s local medical committee (LMC), told Pulse magazine there had been discussions with LMCs across England about rolling out the system nationally by the end of 2017.

The move is driven by anger among GPs about the amount of money put forward for general practice by the government. Buttar said it was essential to look at alternative ways of funding that allowed practices to still operate within the more


Surge in privatisation threatening free NHS treatment, unions say (The Guardian: 8 February 2016)

Trade Unions representing half a million NHS workers have warned that a “surge in privatisation” of the health service risks creating a system based on ability to pay, rather than need.

In a strongly worded statement, leaders of the major health unions representing staff across the NHS said the growing involvement of private companies threatened one of its core functions: the provision of free treatment based on need.

“There is a real danger that if we continue down this road we could end up with a repeat of the American experience where income, rather than need, dictates the level of care a patient can expect,” said the nine leaders of NHS staff, including midwives, nurses and radiographers.

The warning comes as updated figures show the scale of private-sector involvement in the health service since the government’s unpopular shakeup of the English NHS under the Health and Social Care Act more


Jeremy Hunt raises doubts about long-term future of free NHS (The Guardian: 16 July 2015)

Jeremy Hunt has raised doubts about the NHS remaining an entirely taxpayer-funded service in the long term, days after a fellow health minister also warned that soaring demand for patient care could force a rethink on where its money comes from.

The health secretary expressed doubts about the future sustainability of the funding system that has existed since the service’s creation in 1948 after delivering a speech setting out his “25-year vision for the NHS” in London on Thursday.

His comments come days after David Prior, the ex-Conservative MP and hospital trust chairman who recently became a health minister in the Lords, warned that the premise of a tax-funded model would have to be questioned if patient demand for care outstripped economic growth.... read more


Government proposes inquiry into moving to a 'pay NHS' (Our NHS: 15 July 2015)

Imagine for a moment that you are the newly re-elected Conservative Prime Minister, and you want to launch an inquiry into whether the NHS should be paid for in future through user charges and insurance, not through tax.

But you’ve got a problem - you’ve just won an election without breathing a word that you were considering such a fundamental change to the funding of the NHS.

So how would you make such an announcement?

Very quietly, of course.

Last week the government did just that.

If David Cameron, or his Chancellor or Health Secretary had announced such an inquiry to re-consider a principle that has been sacrosanct since 1946, you’d expect front page headlines and Newsnight specials considering the implications. You’d expect a bit of a flurry (to say the least) about whether Cameron was back-tracking from his promises about what voters said was their number one issue.

But the launch of this inquiry has not been reported in the mainstream media, at all.

Why? Because it was casually announced by a little known minister, the newly ennobled “Under Secretary of State for NHS Productivity", Lord David Prior, in the rarefied atmosphere of a House of Lords debate on the “sustainability” of the NHS, moved on 9th July by crossbench peer Lord Patel.... read more


Charging migrants for emergency treatment would cost NHS money in long run, experts warn (The Independent: 16 June 2015)

Government plans to charge migrants for emergency medical treatment would not only make Britain one of most restrictive countries in Europe when it comes to healthcare but could also prove to be a false economy, experts have warned.

The proposal, which has been postponed subject to further public consultation, is to charge undocumented migrants for emergency and primary healthcare, states a paper in the British Medical Journal.

“The UK government wants the public to believe that the changes being proposed will make the country less appealing to undocumented migrants and will save taxpayers’ money. This view is shortsighted and misleading,” it claims.


“Emergency services, which must be provided at the point of need, are exponentially more expensive than preventive or planned care. Furthermore, the NHS can rarely recoup these costs from patients who lack the means to pay,” they argue.

Not having access to preventative healthcare could lead to outbreaks of disease, with its associated costs, and checking the residence status of patients would be a major burden on the NHS, say the researchers.... read more


Patients able to pay for operations to avoid waiting times (Daily Mail: 30 May 2015)

Hospitals are letting patients jump NHS queues for knee and hip replacement surgery if they pay for the operations themselves.

Patients are being charged up to £14,000 for some procedures – almost treble the cost to the Health Service – leading to accusations that hospitals are ripping off the sick.

Knee and hip surgery is being rationed across England, forcing some patients to wait in pain for more than a year to get to theatre.... read more


Two in five fear NHS will soon cease to be free (The Guardian: 23 October 2014)

More than two out of five people fear the NHS will cease to be a free service over the next 20 years, a new survey reveals. When asked how likely it was that the NHS by 2034 would still be free at point of use, 44% said it was unlikely and 37% thought it was likely to be the case.

Women and the less well-off were the most pessimistic. Among women, 48% believe the free NHS will have disappeared, while 36% do not. More men (40%) share that concern, though almost as many (38%) think free care will survive.

The findings, from a survey of 1,030 adults in England by pollsters Populus, come after several thinktanks, groups of health professionals and ex-Labour health minister Lord Warner said the NHS should introduce charges, notably for visiting GPs, as a way of reducing the burden on the taxpayer.... read more


NHS funding crisis: Boss warns of £75-a-night charge for a hospital bed (The Independent: 7 October 2014)

The NHS may have to start charging patients for the “hotel costs” of their hospital stay if the health service’s looming financial crisis is not addressed, senior health service managers have warned.

Hospital bosses will need to “think the unthinkable” if future NHS funding fails to keep up with patient demand, said Rob Webster, chief executive of the NHS Confederation, which speaks on behalf of all health service commissioners and providers.

“If the NHS cannot afford to fund everything, then it will need to make tough choices about what it does fund,” he told The Independent.

“Do we think about increasing our tolerance for longer wait [for care], or do we say ‘NHS funding is only for the health aspects of care and treatment’, which means patients being asked to cover their hotel costs for bed and board?” NHS managers may also have to raise the thresholds at which some minor conditions are considered for surgery, Mr Webster added.

Although detailed plans on charging patients for “bed and board” have not been drawn up, another senior NHS source suggested the fees could be means-tested, and set at around £75 per night.

Any such move would mark a major departure from the founding principles of the NHS, and would likely require authorisation from the Department of Health. However, Mr Webster said, if funding did not keep up with patient demand, “unpalatable” changes would be unavoidable.... read more


Devolution of the NHS could be next. (The Guardian: 16 September 2014)

What of the play, Mrs Lincoln? While the United Kingdom faces disintegration or devo max, its National Health Service may soon face a similar fate. Figures forecast this week will show England’s NHS lurching £1bn into deficit. An unprecedented majority of hospitals are reportedly trading in the red – even the semi-autonomous foundation trusts, for the first time in their 10-year history.

Britain’s NHS is already devolved into England, Scotland and Wales. While Wales has met its crunch and is not protecting health under its austerity regime, England is in the grip of political shroud-waving, as last year when the health secretary, Jeremy Hunt, bailed it out with a previous £1bn. This was variously to prevent another Mid Staffs hospital scandal, cope with soaring A&E demand and “get through the winter”. Billions come and go in the NHS. It knows it is a poor version of a bank, too big to fail.

The day is clearly approaching when reckless promises and thrown money are just not available. Labour may pledge “same-day GP consultations” somehow paid for by “cutting bureaucracy”. But the outgoing NHS boss, Sir David Nicholson, warned in March that the service needed “up to £5bn a year for several years” to rescue it “from oblivion”.... read more


To save the NHS, why not charge those who abuse it? (The Guardian: 18 August 2014)

It says a lot about politics that calling a politician “brave” is seldom a compliment. But Norman Warner is “brave” in a good way, though I disagree with him. Lord Warner, the former Labour health minister, has suggested that if we are to preserve our NHS, we should charge a £10 “membership fee” to help pay for it.

Despite suggesting an answer I cannot agree with, he is responding to the right question – a question so taboo that almost no other politician has had the courage to tackle it. There are other answers apart from his – I for one am loth to jettison the NHS being “free at the point of use” – and we must debate them.

The question we are all frantically evading is how on Earth we continue to fund an NHS that was devised for a much smaller population, with vastly different expectations, at a time of far more limited and less expensive medical possibilities, and when we died much younger. If we do not face this question and find a solution, the very principles of the NHS that we so want to protect – free at the point of use, and based on need rather than ability to pay – may be threatened, because we simply will not be able to afford a first-world health system on this model.

Channel 4’s Dispatches tonight tackles one uncomfortable aspect of this challenge head-on. Despite our much-vaunted national love for our NHS, have we begun to take it for granted? Are we abusing its universality to an extent that threatens the very survival of that which we cherish about it? Dispatches reveals clinicians’ desperation over how our misuse of the NHS hinders them from timely treatment of genuinely needy patients, and their worries how the NHS will therefore survive.

Dispatches exposes the unsustainable number of us who go to A&E who simply don’t need to, hindering the genuinely needy from accessing care. There are many reasons – inadequate information and triaging systems, the fact people see A&E as the “safe” option, and that getting a GP appointment can be so tortuous.... read more


NI health minister sees 'merit' in A&E fees for drunk patients (BBC News: 11 August 2014)

Northern Ireland's health minister has said he can see merit in the idea of charging fees to patients who end up in A&E as a result of alcohol or drugs.

Edwin Poots has recently provided extra resources to try to tackle long waiting times in emergency departments.

However, staff say they are still under severe pressure on a regular basis.

Between April and June, targets to treat patients within 12 hours were missed more than 700 times in Northern Ireland, according to the latest data.

The majority of those breaches were at the Royal Victoria Hospital (RVH) in Belfast and Antrim Area Hospital.

Senior health service staff have in the past appealed for people to only go to A&E units if they are genuinely in need of emergency care. And the health minister is concerned about the number of patients who require treatment because of their own irresponsible behaviour.... read more


Poll shows support for raising taxes to sustain NHS (The Guardian: 16 July 2014)

Voters remain wedded to Britain's taxpayer-funded model of healthcare even as NHS leaders question its sustainability, according to a Guardian/ICM poll. Analysis by NHS England and outside experts points to a large funding gap that could reach £30bn by the end of the decade, and last month 71 leading lights of the health service wrote to the Guardian to warn politicians that failure to level with the public about the black hole before polling day would jeopardise the service's future.

Asked how they would tackle the future funding of medicine, voters are resolved by a margin of more than two to one that "raising taxes for everybody, to put more money in" is the right way to go.

Tax-funded increases in expenditure are preferred by 48% of respondents, while 21% are in favour of charges, such as paying to see the doctor, and 19% would cut the range of available treatments.... read more


Migrants must pay more to use NHS, say ministers (BBC News: 14 July 2014)

Patients from outside the EU are to be charged 150% of the cost of treatment in the NHS in a fresh crackdown on so-called "health tourism".

The move is designed to incentivise NHS Trusts in England to recover the cost of operations from migrants and others.

The UK seeks to reclaim 100% of the cost of treating EU and non-EU nationals where charges are applicable. But only a fraction of the £460m in chargeable procedures performed every year is currently recovered.

Most foreign migrants and overseas visitors can currently get free NHS care immediately or soon after arrival in the UK but they are expected to repay the cost of most procedures afterwards.

The charges are based on the standard tariff for a range of procedures, ranging from about £1,860 for cataract surgery to about £8,570 for a hip replacement.... read more


Fears raised 'free NHS' will come to an end (BBC News: 10 July 2014)

Fears are being raised that the NHS in England will no longer be free at the point of use within 10 years.

Nearly half of the 78 health and care leaders surveyed by the Nuffield Trust felt the status quo would not remain because of the squeeze on funding. The think tank warned of a "funding crisis this year or next" and that patient care could start to suffer.

The government called this an "unrealistic picture", but Labour said NHS finances were in a "dire state". Currently the health service gets just over £100bn a year.

The Nuffield Trust said another £2bn a year may be needed to keep pace with demand.... read more


The NHS budget: Five things we've learned (BBC News: 10 July 2014)

The NHS budget is under the microscope like never before. The coalition may have protected it, but that has not stopped problems mounting.

Earlier this week a host of medical organisations wrote a letter to The Times warning the NHS was "creaking at the seams".

The Nuffield Trust think-tank has now published what is probably the most in-depth look at finances in recent times.

The headline warning is that health care leaders fear the NHS may stop being free at the point of use within a decade. But the report reveals much more than that.... read more


Britain prepared to pay more tax to support the NHS, poll finds (The Independent, 30 June 2014)


A majority of people are ready to pay more tax to safeguard the NHS and head off a looming financial crisis, according to a ComRes survey for The Independent.

Asked if they would be prepared to pay more tax to maintain the current level of care and services provided by the NHS, 57 per cent agreed and 41 per cent disagreed. The finding will encourage Labour, which is considering a plan to include an earmarked “health tax” in its general election manifesto next year.

But the poll also contains worrying news for Labour. Ed Miliband enjoys only a narrow lead over David Cameron on health, traditionally one of Labour’s strongest issues. One in three people (33 per cent) trust Mr Miliband to protect the NHS, while 29 per cent trust Mr Cameron. Three out of 10 Labour supporters (31 per cent) do not trust Mr Miliband to safeguard the NHS, while 64 per cent do.... read more


RCN nurses vote against charges in GP surgeries (Nursing in Practice: 19 June 2014)

Nine out of ten nurses at the RCN Congress believe that patients should not be charged for accessing general practice.

Yesterday, nurses debating the topic in Liverpool voted against the resolution, "This meeting of RCN Congress believes that a fixed fee should be charged for GP appointments." which was suggested by Andy McGovern as a way to start a debate on NHS funding.

Nurses revealed worries that vulnerable people would be deterred from seeking medical help.

The resolution was voted against by 91% of nurses attending Congress.

Dr Peter Carter said this "reaffirms" the RCN's belief that the NHS should be free at the point of delivery, based on clinical need.

He said: “Charging patients for GP visits is a controversial issue – one that goes to the heart of what the NHS is and should be. The future funding of the NHS is shrouded in uncertainty and we need clear direction from our politicians about the way ahead so that clinicians and commissioners can plan for the future.... read more


The NHS funding crisis is now impossible to ignore - which party will grip it? (New Statesman: 18 June 2014)

After four years of austerity, the NHS funding crisis is becoming impossible for the government to disguise. More than one in three trusts (58) are now running a deficit, compared to just one in ten (16) before the coalition entered office. Meanwhile, the BBC reports today that health service faces a funding gap of up to £2bn next year as its budget is burst by rising demand.

All of this was entirely predictable. Contrary to the conventional view that it has been shielded from austerity, the NHS is currently enduring the toughest spending settlement in its history. Since 1950, health spending has grown at an average annual rate of 4 per cent, but over the current parliament it will rise by an average of just 0.5 per cent. Consequently, in the words of a recent Social Market Foundation paper, there has been "an effective cut of £16bn from the health budget in terms of what patients expect the NHS to deliver". Should the NHS receive flat real-terms settlements for the three years from 2015-16, this cut will increase to £34bn or 23 per cent.

If the health service, the most popular spending area among the public (71 per cent believe that its budget should be increased and just 5 per cent that it should be reduced) is to survive in anything like its present form, the question of new funding can no longer be deferred. Jeremy Hunt is involved in talks on additional funding for the next financial year (potentially to be announced in George Osborne's pre-election Budget) but this will only be a sticking-plaster solution at best.

If they wish to avoid a significant fall in the quality and quantity of services, this government and future ones are left with three choices: to significantly raise taxes, to cut spending elsewhere, or to impose patient charges. The third of these is proposed today by the Royal College of Nursing, which calls for a £10 fee for patients to see their GP. If this seems heretical, it's worth remembering that our free health service hasn't been truly free since Labour chancellor Hugh Gaitskell introduced prescription charges for glasses and dentures in his 1951 Budget (although they have now been abolished in Scotland, Wales and Northern Ireland). But unsurprisingly, the Department of Health has responded by dismissing the idea out of hand: "We are absolutely clear that the NHS should be free at the point of use, and we will not charge for GP appointments." Labour, needless to say, takes the same view.... read more


Large majority of GPs vote against charging patients for appointments (Pulse: 22 May 2014)

A significant majority of GPs at the LMCs Conference has voted against the proposal to back patient charging for GP appointments.

In all, 224 delegates voted against the motion, which received intense media coverage after first being covered in Pulse earlier this month. But in the end, only 59 delegates voted in favour, while four abstained.

Proposing the motion, Wiltshire LMC’s Dr Helena McKeown said the time has come to ‘put a true value on general practice’. However, the GPC led a host of delegates in opposing the motion, which was branded as ‘mistaken and dangerous’.

He said: ‘You do not control demand by making patients pay. You then get survival of the richest, not treatment of the sickest.’... read more


Would YOU pay up to £25 to see your GP? Doctors to vote today on charging patients for appointments (The Daily Mail: 22 May 2014)

GPs will today debate whether to charge patients up to £25 for appointments.

The idea will be put to delegates at the British Medical Association conference in York, inspired by a need to deter patients from missing their appointments - a problem that costs the NHS £160 million a year.

If passed, the BMA would then have to decide whether to ask the Department of Health to impose a national charging system.

The potential fees - which would be the first since the NHS was founded in 1948 - could be used to plug the critical shortage in GP funding.

But in a letter to The Telegraph, leading medics have warned the plans threaten to hit the poorest and most vulnerable in society and have a detrimental affect on the nation's health.

Clare Gerada, past chairman of the Royal College of General Practitioners and Dr Clive Peedell, joint leader of the National Health Action Party, have signed the letter, along with 539 doctors and medical students.

It called on BMA delegates to reject the plans, which could involve charges of between £10 and £25.

The letter said: 'User fees are a disincentive to accessing health care, and target the poorest disproportionately.... read more


GPs to vote on charging patients for appointments (The Guardian: 7 May 2014)

Health campaigners have expressed alarm over plans by GPs to vote on charging patients for appointments.

The proposal is aimed at saving the NHS tens of millions of pounds a year by deterring patients from failing to turn up to appointments.

It will be discussed and voted on at the British Medical Association's annual local medical committee conference later this month in York, despite opposition to the idea from doctors' leaders and the general public.

Under the plan, patients could be charged a flat fee of up to £25. The proposed fee is seen as an incentive for patients to turn up to appointments and a way of helping to fund cash-strapped doctors' surgeries.... read more


NHS group considers charges for crutches and neck braces (The Guardian: 16 April 2014)

Patients could be asked to pay for their own crutches, walking sticks and neck braces under proposals drawn up by an NHS organisation to introduce charges for services that are currently free.

GPs in south Warwickshire have sparked controversy by examining how patients who are disabled or recovering from an accident or operation could be asked to contribute towards the cost of devices that are vital to their mobility.

Critics said the proposals were "the thin end of the wedge" and could lead to patients being charged to access core NHS services, hitting disabled and poorer people hardest.... read more


NHS may need to apply more patient charges, says report (The Guardian: 3 April 2014)

More patient charges may need to be introduced in the NHS, including fees for hospital and GP appointments and removing the blanket exemption from prescription charges for the over-60s, according to a report from the King's Fund, which suggests the current health and social care systems are no longer fit for purpose.

Outpatients could be charged £10 for hospital appointments while those who fail to turn up could also be charged as a penalty. Costs for hospital stays or hospital treatment may also be considered. Extending charges for dentistry could also increase revenue, and a fee for visiting the GP – £5 to £25 – could be introduced, the report said.

The report concludes that social care is already in crisis and that the NHS is heading the same way. It points to "hard choices" that must be looked at "squarely in the eye", with several possible means of increasing revenue.... read more


NHS users should pay £10 a month, says former health minister (The Guardian: 31 March 2014)

Everyone in the UK should start paying a £10-a-month NHS "membership charge" to save it from sliding into a decline that threatens its existence, a former Labour health minister has urged.

Lord Warner, who served under Tony Blair, warns that the NHS will become unsustainable without new sources of funding and painful changes.

"Many politicians and clinicians are scared to tell people that our much-beloved 65-year-old NHS no longer meets the country's needs," Warner writes in the Guardian.

"Frankly, it is often poor value for money. The NHS now represents the greatest public spending challenge after the general election. MPs taking to the streets to preserve clinically unsustainable hospital services only damage their constituents."... read more


Who is behind Reform's call for NHS charges? (Our NHS: 31 March 2014)

People in England should be forced to pay a £10-a-month NHS "membership charge" if we want to save the service from ruin, according to a new report by the think tank Reform.

Solving the NHS care and cash crisis also recommends that people staying overnight in hospital should pay ‘hotel charges’.

Reform, which has long advocated free-market reforms to the NHS, is funded by companies which would benefit greatly from the introduction of changes to the way we pay for healthcare. These have included General Healthcare Group, the UK’s largest private hospital firm, but more significantly a large number of corporations in the private health insurance industry.

In recent years Reform has been funded by: Prudential, Legal & General, Scottish Widows, Aviva, Benenden insurance, Gen Re (reinsurer of health products) and US health insurance giant UnitedHealth, which has faced accusations of overcharging and malpractice. The industry’s trade body, the Association of British Insurers, is also a donor.

Prudential was Reform’s most generous funder in 2012, handing over £67,500. What it received in return is not known. Reform describes itself as determinedly independent and states that none of its research is funded by either companies or individuals.... read more


Kings Fund suggests NHS fees - but is it really 'independent'? (Our NHS: 10 April 2014)

The cost of healthcare is rising. We are living longer and technology, drugs, and skills are advancing. We currently spend £111bn (2013/14) on the NHS and we will need to spend considerably more in the future.

Funding the NHS is about choices not affordability. If we invested a similar proportion of our national wealth as Germany and France do (both around 11.5%) the NHS would have about £25billion more than it does now.

Affordability is the wrong question. The right question is what do we prioritise? We could invest in the NHS and make it the best healthcare service in the world. We could refuse to invest in High Speed Rail 2 or the Trident replacement.

Instead this month we have seen two proposals from 'independent think-tanks' about funding the NHS in the future. Both groups suggest we should all pay more through a range of additional fees.

Most worrying are the proposals by The Kings Fund. This organisation has a rich history and was formed in 1897 to help the poor access healthcare in London. This appears to be the last thing on its mind today.

Last week it published its Interim Report on the Future of Health and Social Care in England - 86 pages setting out what its ‘Independent Commission’ think must happen to save the NHS from becoming 'unaffordable' and 'unsustainable'.... read more


Experts hint at future cancer charges (Health Service Journal: 6 February 2014)

Cancer patients may have to pay for some treatments if long-term high-quality NHS care is to be maintained, experts have suggested. There could be “potential rationing of high-value treatments” without such charges, they argue. NHS hospital cancer specialist, Ajay Aggarwal, said: “New approaches to paying for cancer care need to be found.” Dr Aggarwal and Richard Sullivan, director of the Institute of Cancer Policy at King’s College London, have authored a research paper into healthcare system sustainability. It says “user charges could provide a potential means of sustaining spending proportional to the projected rise in the number of cancer cases” in the wake of “stagnating NHS budgets”.... read more


£10 charge to visit your GP: Think tank suggests patients should pay each time they visit the doctor and be fined if they miss an appointment (The Daily Mail: 19 November 2013)

Patients should be charged £10 a night to stay in hospital and £10 every time they see their GP, according to a think-tank. It also wants to raise prescription fees, make dying patients pay for end-of-life care and impose £10 fines for every missed appointment. Reform, an independent think-tank, says the charges could be used to improve certain NHS services such as funding surgeries to open at weekends. It also claims the fees are ‘unavoidable’ as the NHS is incurring billions of debts footing the bill for the care of the aging population. But campaigners fear such charges will unfairly penalise the elderly and those with long-term conditions and may deter them from seeking help. It would also raise prescription costs from £7.85 to £10 and make the elderly and pregnant women pay - currently they are exempt from charges.... read more


Reform Think-Tank Urges Ministers To Extend Charges For NHS Services: (The Huffington Post: 19 November 2013)

Ministers should consider extending prescription charges, as well as introducing new charges on visits to NHS GP surgeries and some elements of hospital care, to raise £3 billion a year for the health service, a think-tank has said. In a report, Reform noted that many other countries charge for elements of healthcare which are free at the point of use in England. New charges on a greater range of prescriptions could raise £1.4 billion, charges for GP visits £1.2 billion and hospital care charges £200 million, said the report. The think-tank recommended that any reform should include exemptions for people on low incomes - but not necessarily for all pensioners.... read more


Anger over hospitals’ 0844 phone calls charge (The Yorkshire Evening Post: 9 November 2013)

The debt-ridden Mid Yorkshire Hospitals NHS Trust earned more than £100,000 in revenue last year from controversial 0844 telephone numbers. Patients ran up higher-than-expected telephone bills after calling the trust, which runs hospitals in Wakefield, Dewsbury and Pontefract. Campaigners say the number is significantly more expensive than a STD code although managers dispute this. The use of the non-geographic telephone numbers, particularly by GPs, has caused anger among patients for years. The Mid Yorkshire has four 0844 numbers which earned it £102,000 in revenue in 2012-13, £66,000 in 2011-12 and £60,000 in 2010-11, at a rate of 4p per call. David Hickson, of the Fair Telecoms campaign, said both GPs and hospitals were charging patients for access to services in breach of fundamental NHS principles and should stop “immediately”.... read more


NHS charges: Hughes-Hallett on paying for health services (BBC News: 31 October 2013)

The NHS is heading for a breakdown if people expect it carry on providing all services for free under increasing demand, the former head of Marie Curie Cancer Care has warned. Sir Thomas Hughes-Hallett gave his view of how to keep the NHS on the road, saying it should - like a a garage - charge "for extras". He said people "need a sat-nav" to point them towards chemists or community support centres and "steer them away from the NHS when they don't need it". Sir Thomas, a trustee of the King's Fund, and Chair of the Institute of Global Health Innovation predicted: "We need to make tough choices for now about what we really need for free".... read more


Patients could soon pay for ‘extras’ like better food, says GP (The Daily Mail: 16 October 2013)

Patients could soon have to pay for ‘hospital extras’ such as better food or IVF, a top GP has warned. Michael Dixon, president of the NHS Clinical Commissioners and chairman of the NHS Alliance, said doctors had to consider introducing new charges to balance the rising costs of treatment and an ageing population. He said patients were already charged for prescriptions and hospital parking, so other services should also be considered. (...) 'Patients pay for parking, the television sets on the wards and if you want to see an osteopath, you have to pay yourself. ‘The very wealthy are doing it already by accessing the NHS when it suits them and going private when they don’t.’ But he added the NHS ‘never allow an NHS patient to live, die or go bankrupt depending upon how much he or she can pay’.... read more


Patients charged £4 to park at hospitals (The Telegraph: 15 October 2013)

The £4 charge for patient and visitor parking at the Birmingham Women's NHS Foundation Trust is more than three times the national average of £1.15 per hour. A further four hospitals charge £3 per hour for parking, including the Liverpool Heart and Chest Hospital NHS Foundation Trust and the Countess of Chester Hospital NHS Foundation Trust. Rates in London were particularly high, with the Royal Free London NHS Foundation Trust and the Whittington Hospital NHS Trust both charging £3 per hour, and Chelsea and Westminster Hospital NHS Foundation Trust charging £2.50. Figures released by the Health and Social Care Information Centre revealed that at 15 hospitals in England parking costs more than £2 per hour, while at dozens of other sites – along with those in much of Scotland, Wales and Northern Ireland – the service is free.... read more


NHS reforms scandal: Hospitals charging patients for treatment that used to be free (Daily Mirror: 26 September 2013)

Hospitals are abusing David Cameron’s NHS reforms to charge patients for treatment which used to be free, Labour has revealed. Shadow Health Secretary Andy Burnham said the secret development was the “next scandal” to hit the NHS. He revealed under the Government’s reforms, the NHS had started rationing healthcare to save cash - while at the same time offering patients the chance to “self fund” their treatment to jump the queue. In total, NHS hospitals have increased their private work by almost £100million since Mr Cameron opened up the health service to profit-making firms. (...) In October 2012, the Government gave hospitals the freedom to generate up to 49% of their income from private patients. Over the following year, hospitals raked in £434 million from private treatment - a boost of some £47 million on 2010/11 when the Tories took power. This will increase by a further £45 million to £479 million by next year, according to projections.... read more


Charges of up to £130 for the sick and disabled (The Independent: 26 August 2013)

Doctors are charging sick and disabled people up to £130 for medical evidence to appeal decisions about their fitness to work, The Independent has learnt. Citizens Advice say in many areas GPs are helping with an appeal only if patients pay a fee of between £25 and £130. There are also reports from 15 of its centres that family surgeries are refusing to provide evidence at all. GPs who refuse to help – or charge increasingly high fees – argue that writing up medical evidence takes up time when they could be helping patients. But Gillian Guy, chief executive of Citizens Advice, said: “Charging sick and disabled people more than £100 for medical evidence beggars belief. This process is clearly failing.” A lack of evidence from doctors will make it more difficult for people to navigate what experts say is an already “flawed” system.... read more


Tories look at limiting GP visits (Evening Standard: 26 May 2013)

Conservatives have considered limiting the number of times patients can visit their family doctor in a year, it has emerged. Documents examining health reforms ask Tory activists if they agree or disagree with an annual cap on the number of appointments patients can book. It is one of a number of options grassroots members were asked to look at in a consultation document, Local Health Discussion Brief, posted on the Conservative Policy Forum (CPF) website.... read more


NHS chief says patients face more charges (The Telegraph: 15 April 2013)

The NHS will have to charge patients for more of its services unless the economy recovers strongly, according to Professor Malcolm Grant, the chairman of NHS England, the new body responsible for the day-to-day running of the service. He notes that demand for the services of the NHS is likely to rise rapidly in the years ahead, and that it would rise faster than the health budget itself, which could force the NHS to start charging for more of its services. The article is based on a report published by the NHS Confederation, in which NHS managers have suggested charging patients for certain services, such as hospital meals and home visits by GPs.... read more


NHS could bring in charges for meals and TV to ease cash crisis (Evening Standard: 18 March 2013)

Patients could be charges to call out a GP or eat hospital meals, and could pay more to watch television in NHS wards, according to The NHS Confederation, in what the organisation terms a “frank discussion” document designed to tackle the “unprecedented financial dilemma” facing the health service.  Proposals include charging patients £8.50 to call an out-of-hours doctor to their home. According to the NHS Confederation, the report - ‘Tough times, tough choices: Being open and honest about NHS finance’ - sets out options, not solutions, by being open and honest about the NHS finances and the choices ahead.

Mike Farrar, chief executive of the NHS Confederation, said: “We need to talk openly and honestly about why our health service needs to change. We cannot risk the wheels coming off and patient care suffering.” Campaigners said the proposals undermine the founding principle of the NHS that care must be free at the point of delivery and warned that seriously ill patients could be discouraged from seeking treatment if they thought they were unable to afford the fees.... read more


More GPs discuss treatment outside the NHS with patients (The Guardian: 21 November 2012)

Longer waiting times and restricted procedures mean that more patients are opting to pay for treatment or care themselves. Half the GPs in one survey said patients were asking about self-pay options because of longer waiting times and patients not fitting the eligibility criteria.

In June (2012) it was revealed that limits on cataract surgery were in place at 66% of trusts in England and more than a half were rationing hip and knee and weight loss surgery. Around 70% of GPs in the BMI Healthcare survey said they were unable to refer patients because of PCT criteria issues at least once a month, whilst in some regions this rose as high as 82%. Nearly a quarter said they encountered this on a weekly basis.... read more


Hospitals accused of creating 'two tier' NHS by charging for some treatments (The Daily Mail: 8 July 2012)

Hospitals are offering patients who aren’t eligible for certain types of care or who don’t want to wait the option of paying for their treatment, according to this article. The hospitals describe the treatment as ‘self-funded’ rather than private and say the payments are significantly lower than those of private clinics. Several hospitals, including Epsom & St Helier Hospital Trust in Surrey and Homerton University Hospital NHS Foundation Trust in London, offer IVF patients the option of NHS, private or ‘self-funded’ treatment.  The practice has raised fears that wealthy patients will be able to jump the queue, while the less well-off suffer. Joyce Robins, of campaign group Patient Concern, said the practice could create a t

More on charges: 




Key facts:

14% increase in self pay in the last 3 years

70% of GPs blame restrictions in NHS treatments

NHS rationing is rising

Hospitals encouraged to offer more private care

Two in five fear NHS will soon cease to be free 

Key trends:

Stricter rules for GPs on rationing (gp examples)

Hospitals offering more private care

More people forced to pay for care


More patients are already being forced to pay?

Related content:

More articles on rationing

Background on rationing

Background on personal health budgets

Background on top-up payments

Ways people could be forced to fund their own health care



Policy controversy:

The current market-led NHS changes are restricting care and driving hospitals, GPs and patients towards private care.

Few politcians openly support fees for care, but policy and funding pressure could mean patients have to pay to top up their care beyond basic levels, and a two-tier NHS could result.

Colin Leys explains "Shrinking of NHS hospitals means free provision will be reduced to being good enough for the poor, and a safety net for the rest"

The costs of healthcare are rising worldwide. Tax rises could be needed and cost savings are being made. What's next, more of the market, more personal responsibilty and new user charges?

The NHS confederation has proposed increasing NHS user charges for GP and hospital visits, which according to Allyson Pollock quite ignores "decades of research evidence about the catastrophic effect that this would have on access and the poor."



Who thinks there should be more charges?

MPs committee says "we are concerned that other savings are being achieved by rationing patients’ access to certain treatments. These include cataract surgery and hip and knee replacements.

The NHS managers organisation says "we identify four tough choices: do nothing; spend more; do more for less; ordo things differently", which could include more user charges.

The government say NHS care will remain free at the point of use, Jeremy Hunt, health secretary, said he would “oppose” the introduction of new user charges into the NHS.


Recent reports:
A report by the NHS Confederation March 2013

Forder, J., Jones, K.,  Glendinning, C., et al. PSSRU Discussion Paper. November 2012.

A report by the King’s Fund and Ipsos MORI based on two deliberative events in London and Leeds in April 2013 

This report for the Nuffield Institute predicts the NHS will be charging for treatment within ten years. It suggested a “review” of the range of services that the NHS should offer free at point of use.
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