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.


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  • rate this

    Comment number 999.

    TurboArrowIII - Putting off an MP pay rise is not going to save £600m a month - it would barely save £10m a year - important not to fall into default position off 'all politicians are corrupt and this is the root of every economic/social problem nationwide.'

  • rate this

    Comment number 998.

    The NHS is not a business, it is a public service so saying it is not economically viable is ridiculous. it is there to serve the public need and not to turn a profit, comparing it to an ailing business is how the government get away with selling off bits of it and eventually trying to charge us more for the privilege
    we all already pay for the use of the NHS by way of national insurance...

  • rate this

    Comment number 997.

    Harry (or is it Sally)........

  • rate this

    Comment number 996.

    If the NHS finally collapses, this would be a very bad thing to people, and it would force people to save more and therefore help cut down more debts for the gov., clever?

  • rate this

    Comment number 995.

    If we just ensured that the people treated by the NHS had paid into the scheme by paying UK taxes and national insurance, no fee would be needed

  • rate this

    Comment number 994.

    956. nicknack1
    If you are ill in another EU country you get free healthcare. Just as you would in any other EU country

    981. tassy
    No it wont, because at that point they wont be able to differentiate between NHS and private healthcare. If you don't eat it then that is your decision.

    987. REECE
    No you only pay while you are working, when you retire you stop paying, but use the facilities more

  • rate this

    Comment number 993.

    Who would monitor this?
    Who would administer this and do the job?
    What if I did not pay and needed urgent care?
    Would I get my money back if I was not happy with the service?
    Will it help jumping queues?

    What not stop this stupidity now, save money now!!

    Job done!

  • rate this

    Comment number 992.

    I don't believe we can't run the country & the NHS on a tax take of 70%, once you've added up council tax, VAT, stamp, inheritance, capital gains etc. Private means less money as profits are taken out, makes it even more expensive

    The NHS is affordable. Give it to an independent management board, that agree long term policy regardless of who's is power, drive efficiency, get the politicians out.

  • rate this

    Comment number 991.

    No. If we do then I will take out private health care cover and I expect to have my NI contribution cut from my wages. I will however agree to pay more NI but only if the government can actually guarantee the extra money goes to the nhs.
    Otherwise this is just another tax. That is all.

  • rate this

    Comment number 990.

    I have a better idea - this unelected Lord, along with all the others, should stop claiming our tax money for themselves and there will be more left for the NHS each year.

  • rate this

    Comment number 989.

    Labour introduced tuition fees of £3000 per annum. Conservatives with Lib Dems tripled those fees to £9000 per annum.

    Imagine what would happen to your £10 per month fee when the governments changed?

    Understandably, political parties are trying to plug gaps in the budget of the NHS. But let us not forget how those gaps materialised

    It was through incompetence and ideologically driven MPs

  • rate this

    Comment number 988.

    @980 - "With 60 million UK people, 10 pound a month per person is 7.2 billion a year."

    Not it isn't. 60m people assumes ALL people in the UK, including children/babies, who I would hope would be exempt from this. If it is only taken from working people, that is likely about a third of the 60m. So it's worse than you think.

  • rate this

    Comment number 987.

    There should be no debate here. We've already paid through taxation.

  • rate this

    Comment number 986.

    Not to forget how we were forced into private dental schemes and eye care, they were a huge savings for the government let alone prescription charges. How come the NHS managed before those were introduced? Ah yes we didn't waste money on the EU and foreign aid.

  • rate this

    Comment number 985.

    Id happily pay the £10 a month. In exchange for the NI payments. For me at least, it represents a huge saving.

  • rate this

    Comment number 984.

    a labour supporter on here said the nhs was okay under labour hes forgot about the thousands of unnecessary deaths at mid staffordshire under andy burnhams and the way the labour party is running the nhs in wales the welsh are coming to england to get free cancer treatment okay under labour you must be joking

  • rate this

    Comment number 983.

    "Well.. This is quite a useless idea reason being I bet the wealthy will probably find some loop hole to get it for free including some private extra health care."

    Yes, "the wealthy" sit around all day wondering how they can avoid paying £10 per month.

  • rate this

    Comment number 982.

    "943.evz As mentioned...WE ALREADY PAY MEMBERSHIP, IT'S CALLED NATIONAL INSURANCE! Idiots in charge."
    None of the current idiots in charge mentioned this, sadly many are not reading the article as its an EX LABOUR health minister and the think thank Reform who came up with this. NHS needs reform, the Lorenzo IT system was or is a pig! to managers not asking for discounts from suppliers.

  • rate this

    Comment number 981.

    it will be a short hop (with no mental reservation or hesitation) from a monthly membership fee to an insurance policy.
    If there is a "hotel" charge just imagine the even greater complaints about having to pay for food which wasn't eaten

  • rate this

    Comment number 980.

    With 60 million UK people, 10 pound a month per person is 7.2 billion a year.
    This is 5.5% of the current 130 billion pound NHS budget.

    First of all, it is not enough to save NHS.
    Second, it is not fair. The NI is proportional to income. A 10 pound/month fee is not proportional to income.

    Third; look at Germany, Netherlands, France. How do they do it ? We have got similar income.


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