Lord Warner’s reform proposals: the shadow of the £10 membership fee
Edmund Stubbs, 4 November 2014
In follow up to his report co-authored with Jack O’Sullivan in March of this year, Lord Warner (previously Minister for Health Reform in Blair’s Government), recently spoke to Civitas’ Health Policy Consensus Group.
Many will remember the report’s headline controversy following recommendations of a £10 per month NHS membership fee. However, before adding to the outrage of many tabloid journalists we must consider a few aspects. Firstly, this membership fee wouldn’t be applicable to those on low incomes, not infringing on the “need rather than ability to pay” principle, a core value of the NHS. Secondly, this would be a monthly charge. In no way would it threaten the NHS being “free at the point of access” as it is not linked to the use of services, and thus completely different from a user fee.
An issue that arises with any flat rate fee is its lack of progressivity; £10 per month leaving one’s bank account will be noticed a lot more by some income groups than others. It is also worth noticing that another of the report’s recommendations: that of a £20 per night hospital fee is a user charge, has many more ideological implications attached. However, to regard these two payments as constituting a single concept would be invalid, doing the former a disservice.
Lord Warner argues that the membership fee is a “double-edged-sword”. While bringing much needed revenue it is an attempt to engage people in their own health care. This is important. He states that systemic change can only effectively be facilitated at the top (health secretary level) or at the roots (the users themselves). Paying a membership fee would encourage a more critically outspoken public; more likely to flag up issues and demand change. Members would also get an annual “health MOT” where they would be given personal health-related targets for the year ahead, thus improving public health and enabling co-produced care between physician and patient.
Lord Warner’s report lays out a detailed plan for reform. It holds many other innovative ideas such as advocating a new National Health and Care Service (NCHS) and concentrating specialised services in 24 hour centres; making them safer and improving outcomes. However, in reforming such a complex, controversial system as the NHS no single plan is likely to present ideas acceptable to all. Lord Warner’s report provides us with a comprehensive menu for reform from which we could select and adapt to reflect current British appetite.
Edmund Stubbs is Healthcare Researcher at Civitas
This is the thin edge of a very nasty wedge. Here is what would happen. Once the “free at the point of use” principle was breached with this, it would result in a general onslaught on the “free at the point of use” ideal. There would be constant pressure to make other medical provision chargeable, for example, paying to go to A and E and paying “hotel” charges when in hospital.
The other thing which would occur is that any charges imposed would be regularly raised, most probably above the rate of inflation. In ten or twenty years “free at the point of use ” would be no more.
Such charges would also boost the piecemeal privatisation of the NHS which is already well under way.
The other thing to bear in mind is that if all those who would not have to pay the charge qualified to be exempt under the same rules as those who are exempted from prescription charges (almost certainly the case), only a small proportion of the total population would actually pay. It would not bring in much money and would be administratively very expensive. There would also be complications because of the devolved powers over health. We could well end up with England alone having this imposed while the Celtic Fringe avoids it.
An all too typical policy suggestion by someone who does not understand either human nature or the administrative implications of what they suggest.