Dorrell rejects new calls to curb free health service

Future of the welfare state: Minister defends principle of NHS for all as concern mounts over gap between resources and demand

Stephen Dorrell, the Secretary of State for Health, yesterday rejected calls for new NHS charges or restrictions on the services now available free, saying the case had not been made that the health service was unaffordable.

Mr Dorrell was reacting to a drug-industry financed report, drawn up under the chairmanship of Sir Duncan Nichol, the former NHS chief executive who is now a director of Bupa, Britain's biggest private health insurer. The report, Healthcare 2000, says a combination of an ageing population, medical advance and rising consumer expectations have left a gap between resources and demands which, without radical action, will continue.

"We do not think it is realistic that the gap can be closed by general taxation alone," Sir Duncan said yesterday, presenting his report, which calls for new charges for the NHS, a restriction on the services provided free, or the possible creation of a "core" service in which those able to afford to could buy quicker access to services or treatments outside the core package.

The report acknowledges the risk that a guaranteed entitlement "would become the minimum that government could possibly provide" but says the challenge must be addressed.

Mr Dorrell, however, said the Government remained "deeply committed" to the principle of an NHS available to all on the basis of clinical need and that access to health care "should not be determined by the size of someone's wallet".

He acknowledged there was a rising demand for health care and that more could be done than ever before. "There is never enough money to do everything all of us would like to do, so we have to make choices."

But there was nothing new in that and the pressures had been there since 1948, he said, adding: "I have not yet been convinced that we have moved into a world where they have become irreconcilable."

The increase in the elderly population in Britain had already taken place, at least as far as the next few years are concerned, and he said of Sir Duncan and his colleagues that "in terms of charging for access to health care, I do not think that they have made out their case".

The NHS was offering a better quality of care than ever before and better quality care than any other comparable system in any other country.

Sir Duncan's report comes days after ministers rejected a call from Rodney Walker, the outgoing chairman of the NHS Trust Federation, for the better off to be given tax-breaks to provide their own health cover, with the NHS becoming increasingly restricted to the elderly, emergencies and the less well-off.

On Monday, the Royal College of Physicians called for an advisory council effectively to advise ministers and health authorities on rationing.

Sir Duncan's report also posed problems for Labour, however, as one member of his inquiry team was Patricia Hewitt, a former policy co-ordinator for Neil Kinnock and former deputy director of the left-of-centre think tank, the Institute of Public Policy Research, who remains an informal adviser to Labour.

Tony Blair's office said the report revealed the "real Tory agenda", which was to shift the NHS to private financing. Margaret Beckett, Labour's health spokesman, said the NHS remained "the best and cheapest was of providing health care".The Royal College of Nursing rejected the idea that rationing was inevitable while the National Association of Health Authorities and Trusts said there was "no reason to surrender the concept of the NHS providing comprehensive and free services". Philip Hunt, the association's director, said: "There is no evidence that the NHS cannot continue to be wholly funded out of taxation, provided it receives year- on-year growth from the Treasury and continues to drive for increased efficiency ..."

Leading article, page 18