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 1059.

    Please read my numerous comments (like 968), addressing the fallacious defence of energy companies, they apply equally to banks;

    At the moment the healthcare market is controlled by largely one party, your apparent fear, the state, who is so insolvent they're stealing your child's wages (who cannot vote), to fund their Ponzi scheme today! Brilliant.

  • rate this

    Comment number 1058.

    " Name not found
    Make all non citizens buy an insurance policy, I have to just to go on holiday anywhere else"

    You have the EHIC available to you to access health treatment on the same terms as locals in 30 EU and EEA countries. It's important to have insurance for (say) emergency repatriation but the insurers require you to hold an EHIC in those countries for emergency healthcare.

  • rate this

    Comment number 1057.

    1045. Diddleypete "people that call for the cancellation of defense ... forget its the defense of this nation that allows the NHS to exist ... Sheesh some people reaaly are dim!"

    Mmm. Especially those unable to spell defence.
    The two things are unrelated. Cancel Trident - a system we could never use - and spend the savings on the NHS. There, did not hurt a bit and all armed forces still intact.

  • rate this

    Comment number 1056.

    The provision of private health services within the NHS was introduced for the first time by Tony Blair's government.

    Now a Labour guy wants to charge us for using it?!

    The hypocrisy of this party is unbelievable.

  • rate this

    Comment number 1055.

    As it would appear that over consumption of food and alcohol cost the NHS an inordinate amount of money, a £1 per visit supermarket parking tax would be an appropriate way of paying for health services.

  • rate this

    Comment number 1054.

    Brit taxpayer and NIS contributor for over 40 years, I thought that I already was a member of the NHS!!!??????

  • rate this

    Comment number 1053.

    We pay for the government and their services through our taxes. The NHS is a service, not a business. Therefore a fee would act like another layer of taxation. Raise the cost of health care for tourists, take out a layer of NHS management fat (the NHS is always telling us to lose weight - well so should you!). I pay tax, I deserve a better service.

  • rate this

    Comment number 1052.

    Anyone contributing tax is already a member of the NHS; the idea perhaps has merit for those who have never contributed tax and NI.

    The solution to the problem of a failing NHS is for politicians to have the courage to make some difficult decisions about what the NHS provides and what it doesn't. And for the electorate to accept the country can no longer afford the current model.

  • rate this

    Comment number 1051.

    I propose that we should charge politicians £10 every time they open their mouth. It would raise far more money and have the added benefit that some of them might actually put their brain in gear first (although that second bit is doubtful).

  • rate this

    Comment number 1050.

    The NHS is adversely affected by the 'Free at the point of need' mantra.
    Why bother to buy aspirin for 25p, when you can get a free prescription paid for by others?
    Why bother to buy medical insurance as a tourist when you can get free treatment in the UK?
    Why bother to wait for a GP? A&E is free, regardless.
    Ultimately, the NHS is spread too thinly and some things should be paid for.

  • rate this

    Comment number 1049.

    This is beyond belief.
    Tories want to go down the Sky TV route.
    How about tougher taxes for millionaires?
    How about stopping all of these ridiculous tax allowance increases for everyone so as to trick them into feeling that they are better off.
    Fair tax for everyone will pay for NHS for everyone.
    Greedy Tories again
    Who votes for these people?

  • rate this

    Comment number 1048.

    Make all non citizens buy an insurance policy, I have to just to go on holiday anywhere else so why should migrants use for free what we have paid into for years to be told now it cant cope. Once you are here over 10 years paying into the system you qualify for NHS like anyone else.

    Im sick of paying for Europe when I dont use any resources bar a checkup once every 10 years.

  • rate this

    Comment number 1047.

    This is the thin end of the wedge. What would happen to those who were unemployed or too ill to work and couldn't afford to pay? Although some of our politicians will deny it, we already have people in this country who cannot afford to eat, often through no fault of their own. I await next year's general election with interest.

  • rate this

    Comment number 1046.

    1020. Joyanblu
    why stop there what about fat people smokers people who drive badly or play dangerous sports.

    They should just say the charge is for your nhs number
    That way it is still free at the entry point

    1014. Diddleypete
    will you continue contributing when you retire

    1031. Ozymandias
    Because you pay for that service for 40% of your lifetime and outside of that time is when it is expensive

  • rate this

    Comment number 1045.

    Ha ha ha..... the people that call for the cancellation of defense to pay for the NHS seem to forget its the defense of this nation that allows the NHS to exist, same for free schooling, benifits, welfare, etc.. Yep, without being able to defend this country, you would probably have none of that..... Sheesh some people reaaly are dim!

  • rate this

    Comment number 1044.

    History instructs that in times long gone by, black folk & labourers on USA cotton & tobacco plantations, chinese USA railway builders, UK canal builders, miners & many others employed used to be paid a poor pittance of a wage &,

    tools, food, lodging, etc, were all deducted by "the man", leaving the worker little for his toil & labours.

    And still, there are dirty hands in honest pockets!

  • rate this

    Comment number 1043.

    1034.Unbelievable Tekkers
    It's a fact of life for businesses that they will have bad debtors.
    And people who can't/won't fork out £10/month aren't likely to be good debtors.
    I accept that, but it does not excuse them option out then expecting the service. The only other answer I see to what you propose is the £10 is not optional but mandatory.

  • rate this

    Comment number 1042.

    Perhaps £10 a month might not be so bad if we got free prescriptions and free dentistry out of it - you, know, the things we currently pay for. Even if you have an NHS dentist, nothing is free as even a check-up comes with a clean and descale costing getting on for £20.

  • rate this

    Comment number 1041.

    @201. Henry Hazlitt " . . . . Competition creates abundance . . . ." Really? Truly? Like there are abundant energy companies to choose from or a myriad of banks? Competition in services of the scale of the NHS just ensures that someone ends up controlling the market or a small group of mega sized corporations acting in concert do. The shareholder then becomes more important than the service user.

  • Comment number 1040.

    This comment was removed because the moderators found it broke the house rules. Explain.


Page 20 of 72


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