At last – an attempt at philosophy. (Utilitarianism) Patients must pay extra for NHS, leading doctor says

This is a very important article and could be used as a springboard for politicians to face reality. But somehow I doubt it as the statement was not picked up by the BBC. Clare Gerada is well aware of the issues ahead.

Patients must pay extra for NHS, leading doctor says

Chris Smyth Health Correspondent The Times October 16 2013

Patients will have to pay more for hospital services and lifestyle treatments  to head off a financial crisis in the NHS, a leading GP said yesterday.

Michael Dixon, president of the NHS  Clinical Commissioners and chairman of the NHS  Alliance, demanded an end to the “taboo” surrounding top-up payments.  Extras, such as better food, more comfortable beds, or treatments including  IVF, could all be charged for, he suggested.

Doctors could not keep demanding more money from the taxpayer and had to think  of ways of raising cash themselves, Dr Dixon said. People are already  charged for prescriptions and hospital car parking, so it was “prissy” to  rule out payment for other services such as false teeth or cosmetic  operations, he said.

As long as patients did not die because they could not afford treatment, they  could be charged for hotel-style perks or therapies that are rationed at  present, he said.

Dr Dixon, who represents the GP-led Clinical Commissioning Groups, which buy  services for patients, said that these local groups should “be a bit  experimental” and see what kind of charges worked best.

Patient leaders have warned of a “slippery slope” if charging is expanded and  say that the NHS had to cut down on waste before asking patients to pay more.

Speaking at a Westminster  Health Forum event on the future of the NHS yesterday, Dr Dixon said  that charges had to be considered. The health service is facing a £30  billion funding gap by the end of the decade because of an ageing population  and the rising cost of new treatments.

“We need to start discussing the real taboo subject of the NHS, which is  co-payment,” he said. “No one wants to discuss it but it is already  happening. Patients pay for parking, the television sets on the wards and if  you want to see an osteopath, you have to pay yourself. The very wealthy are  doing it already by accessing the NHS when it suits them and going private  when they don’t.

“If the NHS gets squeezed, it will need to make as much income as it can but,  for my money, it must never, never, never allow an NHS patient to live, die  or go bankrupt depending upon how much he or she can pay.”

Speaking personally, Dr Dixon suggested: “If someone wanted a surgical  procedure or medicine that didn’t have a proven benefit they could pay for  that and also for someone else to have another treatment.

“Things like car parking or television sets are fairly easy, then on the edge  of that, what about dining-room extras like food, or more comfortable beds?  I don’t think we should be too afraid of this discussion because the  alternative is rationing where no one can have it.”

Figures from the Health and  Social Care Information Centre released yesterday showed that some  hospitals spend three times as much as others on food. Barnet and Chase Farm  Hospitals NHS Trust in London spent £4.15 per inpatient per day, compared  with a national average of £9.87. Others spent up to £15.

Some hospitals are also charging £3 an hour for parking, three times the  national average, data from the Information Centre revealed.

Dr Dixon added: “It’s about being inventive in how we create income in the  health service so that we can get more resources to look after patients and  don’t continue going back to taxpayers saying ‘can you give us more’?”

He said that only if patients took more responsibility for their own health  could debates on rationing and fees be avoided.

Under recent reforms, the GP-led Clinical Commissioning Groups were given £65  billion of the NHS budget to spend on local services. Dr Dixon said it was  “completely bonkers” that they could not spend it on GP projects because of  conflict of interest rules.

Doctors urged the British Medical  Association this year to back top-up charges to cope with rising  expectations and budget cuts. The association voted instead to draw up a  list of “core” services to define what patients could expect from the NHS.  Dr Dixon said that it would be better for local areas to decide on their own  priorities.

The Times Letters October 15 2013

Surely it is more virtuous and fair to have overt rationing rather than the covert rationing we have now, especially the post-code lottery, along with Bevan’s “frontier” issues.

Update 21st October 2013:

So the letter from Micheal Dixon (NHS charging – utilitarianism) in reply to correspondence in his Times article is pertinent. He wants an honest an open discussion – same as NHSreality does.

Here it is in full

NHS charging

Times Letters – October 21 2013

Co-payment in less crucial areas may be acceptable in difficult financial times if that ensures fairness and equal access

Sir, In response to Professor Martin McKee and Professor Lord Winston (letters, Oct 17), my point on co-payment was that, when NHS finances are stretched, this should not be a taboo subject. My argument was utilitarian. Some unfairness (in terms of co-payment) in less crucial areas may be acceptable in difficult financial times if that ensures fairness and equal access where medical interventions can make a significant difference. This would need to be the collective decision of clinicians and patients locally or nationally. I would not presume to decide which are those appropriate areas.

Many of my under 65-year-old patients are going to a local supermarket to pay for their flu jabs. Co-payment is effectively already happening. My aim was only to stimulate an open and honest debate.

Dr Michael Dixon
Chairman, NHS Alliance, president, NHS Clinical Commissioners

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About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

1 thought on “At last – an attempt at philosophy. (Utilitarianism) Patients must pay extra for NHS, leading doctor says

  1. Pingback: Unwilling to discuss philosophy – ask Frank for a “financial solution”! | NHS reality. An NHS soapbox. Speakers' corner for the NHS.

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