Simon Stevens, until recently a vice-president of the US health giant United Health – and ersthwhile Blairite health adviser to New Labour – took over this week as the NHS chief executive. It can hardly have been by chance that his arrival coincided with two new reports recommending the introduction of up-front charges for NHS care –one from the King's Fund, the other from an unholy alliance between the former Labour health minister Lord Warner and the rightwing thinktank Reform.
Both reports start from the unchallenged but erroneous assertion that the NHS is "unsustainable", and are padded out with a plethora of platitudes about more care in the community and the merging of health and social care services. But at their heart are radical recommendations for the introduction of upfront charges for the NHS. In the case of Reform, this would be a "suggested" £10 "membership fee" a month.
Research is clear that charges of this sort deter the poor and the elderly – the very people who need the NHS most – and as a result they present later with more advanced illness. To Warner and the pundits at Reform £120 a year may not look much, but it will feel like the last straw to those already struggling with the consequences of austerity. The public understand this and, as a recent survey shows, are overwhelmingly against upfront payments.
There is no financial, ethical or clinical argument in favour of upfront charges for the NHS. The most efficient and the fairest way of funding it is through progressive central taxation. Flat-rate charges, such as those proposed, would need to be means-tested, a fact that Warner was forced to concede in a radio interview. He also admitted that the charges as laid out would only raise £2bn a year, a drop in the ocean of the NHS funding gap.
This raises the question of the point of introducing a system of means-tested charges that would almost certainly raise less money than it would cost to administer. But there is no secret about the agenda here. Reform is funded by the very people who would benefit from undermining the fundamental principles of the NHS. The list of their donors includes major insurance companies, management consultants and private healthcare providers.
Reform is essentially a third party speaking for those whose voice – for good reason – is not trusted; it is a front for the health industrial complex, which for years has worked to get its hands on the NHS budget. They understand that once the fundamental principles of the NHS are breached with upfront payments, it will be a short step to top-ups, co-payments and insurance to cover the escalating charges. Hence their enthusiasm for the big conversation about the "unsustainablity" of the NHS and their solution of saving it with modest direct charges. Who could possibly be churlish enough to say no?
It is no surprise that neither report mentions far better ways of raising or saving money for the NHS: £10bn a year could be saved by ending the market in the English NHS, many more by tackling the PFI debts emptying taxpayers' money into share holders' pockets – £11bn of infrastructure is costing us over £60bn to fund. But these solutions would not benefit the backers of Reform.
No politician with any sense would publicly endorse these proposals for charges, but nevertheless they have served their purpose: they have reinforced the myth that the NHS is "outdated and unaffordable", and re-animated the zombie policy that it could be saved by upfront individual payments. With phone-in hosts trying to persuade callers that it would be entirely reasonable to pay less than the cost of a tin of salmon each week to save the NHS, Reform's corporate backers must consider their money to have been well spent.
The rest of us will view this as a poll tax for the NHS and act accordingly. Simon Stevens, as he takes over the reins of the NHS, should not underestimate the strength of public feeling against undermining one of the founding principles of the NHS.
