The NHS has to change dramatically to survive the impact of the economic downturn, a report claims.
The report From feast to famine: reforming the NHS for an age of austerity says the NHS has to become much more efficient, and change its approach to what is fair, if services are not to be compromised by the crisis in public finances.
The report by the Social Market Foundation argues that while it’s unlikely further funding will be raised, there is potential for the NHS to manage demand and get better value from existing money.
The NHS must recognise that fair does not necessarily mean free, the report says. Charging patients for access to healthcare, as they do in many European countries, offers the NHS the best chance of making people think about how to ration their own use of health resources.
Charging does not undermine the principle of fairness in securing equal access for equal need. The report suggests that the NHS charging system should be reformed to reflect income, not categories such as pregnancy or retirement; anyone receiving tax credits should be totally exempt from NHS prescription charges; a charge of £20 for GP appointments should be introduced to encourage healthier, wealthier people to avoid using the NHS unless absolutely necessary, with an exemption for those receiving tax credits; and, NHS charges for GP appointments and prescriptions should be capped at around £100 per year.
Co-author David Furness said: “Free care for all will end up making the NHS less fair. The alternative to getting people to ration themselves is a return to rationing by stealth - waiting lists, crumbling hospitals and poor quality services - which hits hardest the poor and sick.”
Other recommendations to promote efficiency in services include: Local contracts for GPs and consultants; a new Royal College of Commissioners to give commissioning higher status; and, new powers and responsibilities for commissioners to improve the quality of healthcare providers.
Co-author of the report Barney Gough said: “Central government will not be able to drive the efficiency savings the NHS needs to survive. Instead responsibility must be given to autonomous local commissioners to work with local people to design a range of services appropriate to their needs.”
The BMA’s Chaand Nagpaul said charging for GP services would undermine the doctor-patient relationship and deter patients who needed care.
Read the full report.
Tags: Commissioning, Funding
