The idea of charging NHS patients who abuse the system has a superficial appeal. Edwin Poots, Northern Ireland health minister, has suggested issuing drunks who end up in the province’s already overburdened accident and emergency departments with a bill for the cost of their care.
It is easy to understand his frustration when A&E departments are besieged, targets have been missed and delays may have contributed to deaths. Mr Poots has had to find extra cash to tackle the long waits.
Targeting drunks and drug users would deter excessive consumption, ease the pressure on the health service and secure payment from those whose need for treatment is self-inflicted. Why should the NHS pay to patch up people whose sickness or injury is caused by their own irresponsible behaviour?
Superficially appealing maybe. “The principle [of charging] has merit,” Mr Poots said. But how would doctors and nurses decide who was to be charged? And how are we to define “irresponsible” behaviour? An injury suffered on the sports field might be deemed self-inflicted – but so too might the illness suffered by the spectator who spends too long on the TV couch.
Obesity, pregnancy, sexually transmitted infections, various cancers (from smoking or lying in the sun) might also qualify as self-inflicted. And aren’t most injuries the result of some degree of carelessness for which the injured parties are often themselves to blame?
Charging drunks for treatment at A&E would be a stalking horse for charging the sober – an illustration of ministers’ desperation to find new sources of funding to sustain the tottering health service. It would raise little in the way of funds, sow discord among medics and patients and undermine the principle of an NHS free to its users.
There are better ways to deter excessive drinking – health warnings on cans and bottles of alcohol were recommended yesterday by an all-party group of MPs – and better ways to raise cash for the NHS. Tax increases, not charges, are the painful but necessary way ahead.