Should we pay a monthly membership fee to the NHS?

Ten pound notes Should we give the NHS one of these each month?

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.

Hotel room Should the NHS charge like hotels?

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.

Start Quote

New streams of dedicated revenue are required to allow the NHS to remain largely tax-funded and free at the point of deliver”

End Quote

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.

Start Quote

It is a perfect storm.”

End Quote

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.


More on This Story

The BBC is not responsible for the content of external Internet sites


This entry is now closed for comments

Jump to comments pagination
  • rate this

    Comment number 519.

    Why don’t the government attach a nipple to our debit cards --- it will make ‘milking the public’ so much easier?

  • rate this

    Comment number 518.

    Ah, the Back Door to Tory privatisation.

    Reform is an independent think tank, Hmm.

    We pay taxes for the NHS.


    How about the government coming down hard on Corporate tax evasion and off shore tax havens used by the very wealthy and big business.

    Of course this would mean that for the first time the Tory’s mates might have to pay taxes like the rest of us.

  • rate this

    Comment number 517.

    I already pay for the NHS through taxes and have rarely used the service. I currently have private health care so I will not be paying for this national service!!!

  • rate this

    Comment number 516.

    Every penny of the 10 pound monthly fee will be spent exclusively on maintaining the NHS, just like the Road Fund Licence was spent exclusively on maintaining the roads. Who are they trying to kid.

  • rate this

    Comment number 515.

    Don't we pay already? Isn't that what National Insurance is for?

  • rate this

    Comment number 514.

    No, no, and no again. Free at the point of delivery of care. This was the principal, and that is what it should remain. Beware of the right wing and it's vested interests. I wonder if any of these "thinkers" have shares in private healthcare companies ?

  • rate this

    Comment number 513.

    The basic problem with public services is that the providers never recognise the customer. Since they get the their money printed by the government, they think the people who turn up at the door will accept any old rubbish, after all they aren't paying for it. Solve that problem and you will fix schools/NHS/councils, etc.

  • rate this

    Comment number 512.

    All the fake neo-liberals are out in force I see, the ones who don't even pay tax because they still live with mummy and daddy. They can't quote a decent private healthcare market anywhere in the world because they do not exist.. The private American healthcare system is far more expensive than the NHS and far more inneficient.

  • rate this

    Comment number 511.

    Yeah lets pay an extra tenner a month then watch £9,99 be spent on administering the scheme.
    Just another layer of bureaucracy and red tape.
    Anyway, what about NI? That's supposed to be what we pay for our health care.
    They want a tenner a month membership fee, then drop NI contributions by a couple of %

  • rate this

    Comment number 510.


    The unsustainability of the growing demands upon NHS is just a simple & basic reflection & consequence of endemically unsustainable & destructive human actions.

    The corrupt perception of PC BBC & other PC armagedonist PC pirates is that this planet & human growth is no problem, we can meet the demands/needs of rising populations

    Erm - facts/evidence/reality prove this is BULL(sugar)

  • rate this

    Comment number 509.

    The medical profession want the NHS to go the way dentistry.
    That is so expensive now and dentists so well paid that we have the worst teeth in Europe.

    Dentists and GPs and specialists will never accept that they are over paid and will always want more.

    Remember that the BMA and the Tories tried to prevent the creation of the NHS.

  • rate this

    Comment number 508.

    How about raising tax and NI? You could do that easily if we weren't all being strangled to death by the Buy-To-Let market. The cost of accommodation should be driven only by the need for accommodation, not by people needing shelter competing with rent-seekers buying it up to idly profiteer from the needs of working people.

  • rate this

    Comment number 507.

    496 Socialist Network
    Congratulations...Good to see a sense of humour in the face of the negativity.
    Sound thought, good sense ,kindliness and respect...and regretfully strength when disregarded.
    Wishing you success
    Continue to stare 'em down.

  • rate this

    Comment number 506.

    What is the difference between a £10 membership fee and £10 on your taxes ? Another "clever" soundbite from politicians.

    Also note how they think £10 / month sounds less than an annual bill of £120.

  • rate this

    Comment number 505.

    The NHS has become self serving behemoth far more concerned with preserving institutions and practises than looking after patients. With waiting times to see any of the GPs in the local medical centre between 2 to 3 weeks and no one doing about it it is immoral to propose additional taxes for this monster. Close uneconomic or failing hospitals & reopen them on an affordable basis if needed.

  • rate this

    Comment number 504.

    Sense real danger here! Just checked "Silver" cover from a mainstream prvt. hlthcare provider; this comes out at just under £12/mth. Start charging folks a £10 "top-up" to continue their NHS access, and they will soon start voting with their feet, switch to what might be perceived to be "better" private cover instead, and evade NHS "top-up" fees. NHS withers & dies - exactly what this govt. wants!

  • rate this

    Comment number 503.

    "NHS Poll Tax
    daft in a society unequal
    redundant in agreed democracy"

    In equal partnership: no pay bargaining, no need of saving for home or car rental.

    No need to 'save' for pension, health insurance, school.

    All free to get on with life, with creation of value, competing to be our best, NOT at the same time against each other's fundamental democratic right (to be equal in the market)

  • rate this

    Comment number 502.

    478.Last Socialist
    1. How long do waiting lists need to get?
    2. How much more rationing or denial of care to those who faithfully paid NI thoughout their lives?
    3. How many more abusive and deadly scandals from Ely to Stafford Hosptials?
    4. How much more taxation upon our children's future wages to pay for us today (debt slavery), will it take?

    Until you wonder; was socialism a good idea?

  • rate this

    Comment number 501.

    I work in the NHS and paying £10 month is not a good idea because the way the NHS service run. There is a lot of waste,and people would not get value for money. If there is a option to pay extra for medical services I would like to pay into a private medical insurance. The NHS is to big for the goverment to run. The NHS has to change and stop wasteing public money.

  • rate this

    Comment number 500.

    #476 We may need to pay more, or alternatively, the government could adjust its priorities by reallocating money from the likes of Trident, or HS2, or even heaven forbid, even raise the tax rate. We already pay for the NHS through the tax/NI system, and I'm surprised this comment came allegedly from a Labour Lord. Still, it's Monday morning and HYS likes to start the week with bonkers ideas.


Page 47 of 72


More Health stories



BBC © 2014 The BBC is not responsible for the content of external sites. Read more.

This page is best viewed in an up-to-date web browser with style sheets (CSS) enabled. While you will be able to view the content of this page in your current browser, you will not be able to get the full visual experience. Please consider upgrading your browser software or enabling style sheets (CSS) if you are able to do so.