Should we pay a monthly membership fee to the NHS?
There are many views about what the NHS should do to cope in the current financial climate.
In this Scrubbing Up, former Labour health minister Lord Norman Warner and Jack O'Sullivan, head of a social policy consultancy, who have written a paper for the think tank Reform, set out their thoughts - including a £10 monthly membership fee.
You might think that all adults (with some exemptions) paying a £10 monthly NHS membership fee would have little impact on an organisation with a budget running at £130 billion a year.
But it's a change that just might help rescue the NHS from its combined care and cash crisis.
Think first about the caring side. The NHS is in serious trouble.
Frail elderly people, those with chronic conditions or mental health problems and those developing obesity and life-style related illnesses often receive very mediocre care.
Too many of them fail to receive help at the right time in community-based health settings.
Eventually, they may be treated in hospital - a much more expensive setting - when they are sicker than they should be and when they could have been cared for earlier, in less costly environments.Annual MOT
That could all begin to change by making NHS membership a key element of citizenship, creating a new relationship between the state and individuals, 'co-producing' personal health.
Each year, you would have a Health MOT when you and the NHS would agree responsibilities for self-care and services in the coming year.
And the £10 a month, collected with the council tax, would go straight into developing impoverished local community health services.
A membership scheme might also get people more engaged with how we must transform our NHS - shifting resources into merged health and social care services, delivered from revamped community hospitals, open 24/7, and supported by consolidated GP practices.
Under our proposals, specialist hospital services would be concentrated in fewer, safer, better equipped and more expert centres with 24/7 consultant cover and improved transport links.
We know this move would save lives, as has already happened with consolidating emergency stroke care in fewer London hospitals.
New streams of dedicated revenue are required to allow the NHS to remain largely tax-funded and free at the point of deliver”
The membership fee is just the beginning of our plans to expand the tax base for health care.
We must grasp this nettle, because, even if the care side is fixed, the NHS will still need small above-inflation rises every year.
New streams of dedicated revenue are required to allow the NHS to remain largely tax-funded and free at the point of delivery, but not starve other public services of resources.'Sin' taxes
We suggest a host of well-documented, but currently unimplemented, efficiency improvements.
These include sell-offs of under-used assets for a £15 billion "service transition fund" to renew the NHS.
We also detail much tougher taxes on tobacco, alcohol, sugary foods and drinks, and gambling, to be spent only on health and care.
Elderly people, the biggest consumers of healthcare, could contribute more, albeit after they die: it cannot be fair that just 3.5% of the annual 500,000 deaths lead to payment of inheritance tax.
It is a perfect storm.”
Some NHS 'free' entitlements, such as 'continuing care' might have to be reduced or means-tested.
Hotel charges for hospital stays could be introduced, as in other European countries.
We cannot afford to ignore these issues any longer. The NHS care crisis remained largely hidden in times of plenty.
Now, amid austerity, it is exploding into a full-blown cash crisis.
The NHS, facing a £30bn deficit by 2020, is becoming economically unsustainable, given our tax base, the state of the public finances, changing population needs and the implications of scientific development.
Meanwhile public expectations of services continue to rise.
It is a perfect storm.
Our study, 'Solving the NHS Care and Cash Crisis', is published today as Simon Stevens takes over as the new chief executive of NHS England.
It makes clear the need for strong political and clinical leadership.
Our public figures must be brave, backing Stevens and facing uncomfortable truths - helping us, the NHS membership, to see the true picture of what has to be done to save our NHS.
Lord Norman Warner was a Labour health minister for NHS reform and Jack O'Sullivan leads a social policy consultancy. Their study, 'Solving the NHS Care and Cash Crisis', is published by Reform, the independent think tank.