The alarm is certainly shared by nurses in the health service. Proposals ranging from cutting exemptions from prescription charges to charging for visits to the GP will undermine the very basis of our health service.
So far the debate has focused only on how to save money. But what of the impact on patient care and the uptake of services? Charging for GP services will make patients more reluctant to visit their GP. It will put even more pressure on already over- stretched hospital services: people will avoid the fees by attending accident and emergency centres and more patients will be forced to hospital with serious conditions developing due to a lack of early, preventative intervention. Charging for convalescent care may lead to patients discharging themselves early, putting extra pressure on community health services. This flies in the face both of current Department of Health policy and economic logic.
The Government repeats its manifesto commitments to a universal health service but these latest proposals threaten to undermine the very basis of that service. It is easy to argue that the wealthy should be required to pay for services they can afford, but it seems a likely consequence that the wealthy will prefer to insure themselves against the possibility of payment. This is already happening in the dental service. We should learn from the US that the division between the wealthy and healthy insured and the uninsured poor is not going to provide a cheap healthcare system.
We should challenge the repeated assurances from Michael Portillo that no options have been ruled out. Has the Government not ruled out increased expenditure through increased taxation? Should we accept the assumption that cuts must come from the NHS budget? No one denies that avoidable or wasteful spending should be challenged. But what of efficiency and more effective use of existing resources? What of investment in preventative health care and health promotion?
Long-term health gains, and ultimately cost savings, might be generated by a real and lasting shift in policy. But this will not occur overnight. We must not allow crucial decisions on the future of the health service to be rushed through to meet the autumn public expenditure deadlines.
Royal College of Nursing
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