Bernard Ingham: Time to decide what really is sacrosanct in the NHS

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UNLESS I’m a Dutchman, I think we are being softened up. Twice in four days people have advocated charging us a fee to see the doctor and other ways for the NHS to relieve us of our money.

First, Lord Warner, a former Labour Health Minister, proposed a £10-a-month NHS membership fee and hotel-style charges for stays in hospital.

Then, the Commission on the Future of Health and Social Care in England came up with a fee of anything from £5 to £25 for visiting a GP or an A&E unit, a charge of between £10 and £50 for hospital appointments and limiting free prescriptions to poorer pensioners.

And a poll of 100 MPs found 48 per cent of them fear that a “free” NHS may not survive, though 65 per cent doubt whether there is the political will to bring in charges.

If all that does not add up to the first round in attacking the founding principle of an NHS free at the point of delivery, then I’m a Double Dutchman.

We had better get used to the idea that moves are afoot 65 years after its foundation to change the basis of our access to the NHS. It will not happen overnight. Indeed, 65 of the MPs surveyed suggest it will be some time before our politicians summon up the courage to make us supplement the funding of the NHS.

But this is not going to go away. The pressure could intensify after the next election because of the overriding need to eliminate the s budget deficit and start paying off the £1.3 trillion debt mountain.

After all, servicing the national debt costs nearly half the £132bn the nation spends on the NHS. If that were eliminated, some at least of the pressure on health spending would be eased.

But it would not go away. This is because there are two built-in escalators in health spending – an ageing population and the relentless march of medical science and technology.

In short, the time has come to face the music. If, like me, you have a certain reverence for the NHS and its availability free (after tax) to all who need it, we must sort out our ideas. What is sacrosanct and where, if at all, could we contemplate breaching the founding principle?

First, we have to recognise that the NHS is open to exploitation. Its founder, Aneurin Bevan, soon discovered that. Within a few years he was bemoaning “the cascade of pills down the nation’s throat” GPs are fairly regularly accused of over-subscribing, latterly rather dangerously by dishing out antibiotics and so encouraging resistant bugs.

Second, the NHS is nightly abused by drunks and druggies and people who cannot keep their fists to themselves. Whether we like it or not, it is also milked daily, whether by design or accident, by foreigners who have not paid a penny towards its costs.

Third, it allows itself to be exploited by people whose lifestyle virtually ensures health problems as well as those who see it as a cheap branch of the cosmetic industry.

In fact, the principle of a “free” NHS at the point of delivery went out of the window when prescription charges were introduced. Now they are suggesting better-off pensioners should pay for them like the workers. That idea worries me – not because I am a pensioner but because it could cause real hardship if it were not properly means tested.

For the rest, I think it is outrageous that addicts of various kinds and the riff raff should assume that the NHS will salvage them free of charge. We should find a way – if necessary by a “resident” magistrate – to dispense on-the-spot fines for their burdening the system and getting in the way of the deserving.

We should end the NHS’s deliberate exploitation by immigrants and health tourists who are battening on our generosity. There should be no question of free cosmetic surgery, except to rebuild the lives of those cruelly shattered by accident.

Whether those who can afford it should at least pay for their food in hospital – always assuming it is left where they can eat it – is a more open question.

But I am adamant that not a single new charge should be introduced until the medical profession offers a 24/7 service by GPs and hospital consultants. That would instantly reassure patients and ease pressure on A&E units.

It would also help if bureaucrats and managers cut out waste. Too frequently they are accused of feathering their own nests. Physician heal thyself.