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NHS `to charge or face cut in role'


Public Policy Editor

Charges for the National Health service or a cut in the services provided free look to be inevitable, a report from a health care commission warns today.

The quality of health care is under threat, according to Healthcare 2000, whose members include Sir Duncan Nichol, the former chief executive of the NHS, and Patricia Hewitt, a key Labour Party adviser.

The forum, established to take an independent look at health care but with pounds 100,000 in finance from the drug industry, says demographic change, scientific and medical advance and rising consumer expectations have created a gap between resources and demand.

The quality of health care is under threat, it says. "Without radical action, the gap will continue," says Sir Duncan, now professor of health services management at Manchester University. "Additional funding and/or a redefinition of what is provided free at the point of use is needed."

The forum - whose other members include two members from the pharmaceutical industry, Linda Lamont from the Patient's Association and David Knowles from the King's Fund health think-tank - says that what is provided free on the NHS must be reviewed.

Given the breadth of the forum's membership, its assault on the principle of a comprehensive NHS free at the point of use may prove the most significant yet. Critics, however, are likely to challenge its independence given the degree of the pharmaceutical industry involvement and Sir Duncan's role as a director of Bupa, the private health insurer.

"We are committed to general taxation remaining the principal source of funding health services," the forum says. "However, we believe it is not possible to expect the continuing gap between resources and demand to be closed through increased tax funding alone.

"Increased tax funding may play a part, but it seems the gap will be effectively reduced only by a combination of strategies which include a clearer definition of what services will be provided free ... and by raising the proportion of healthcare funding provided by individuals."

That could be done by new charges or by other forms of patient payment.

Despite its recommendations, the commission says there is "no conclusive evidence" that the NHS is underfunded, but international comparisons, explicit rationing of some services and public opinion leads it to conclude that a gap exists that is likely to increase.