NHS charging dilemma splits the experts

Two reports reveal disagreement among NHS organisations on whether patients should be charged for NHS treatment. Jeremy Laurance, Health Editor, says it is an issue that will not go away.

A radical government with a large majority should have the courage to consider charging patients for NHS treatment as a way of paying for improvements in the service, a specialist in public policy says.

Geoffrey Hulme, of the Public Finance Foundation, the research arm of the Chartered Institute of Public Finance and Accountancy, says it is unlikely that government revenues will be sufficient to meet the needs of the NHS through taxation alone in the short or long term. The NHS is, in a word, unaffordable.

But the NHS Confederation, representing health authorities and trusts, has ruled out charges as inequitable and inefficient. In a report published today, it says making patients pay for visits to the GP or for hotel charges in hospital would deter some from seeking treatment and damage their health.

The debate about NHS charges began in the summer after Frank Dobson, the Secretary of State for Health, refused to rule them out when questioned about the Government's comprehensive spending review. The British Medical Association later issued a report suggesting charges could raise up to pounds 5bn extra for the NHS, but said it favoured raising the extra cash through taxation.

Writing in the Public Finance Foundation's Review, Mr Hulme says if user- charges were introduced, the better-off should pay more and they should be used only for buying extra services which cannot be paid for in other ways.

"Their main advantage is that they are a tax which citizens know will go to the services they want to use, and they will pay at a time when they have the maximum interest in the services," he says.

The NHS Confederation says general taxation "remains the fairest and most cost-effective source of finance for the NHS."

However, the confederation adds that a minimum 3 per cent annual increase above inflation is needed to meet increasing demand and medical advances. This year the increase is 1.37 per cent and in 1998-99 it is 1.66 per cent.