Efforts by campaigners to stop GPs, Hospitals and other NHS service providers from obtaining clear subsidy from patients by use of expensive "revenue sharing" 084 telephone numbers were thought to have succeeded. [see petition]. On 14 September 2009 it was announced that use of these numbers was to be banned. [see DH press release]
Directions to NHS bodies, to this effect, were issued on 21 December 2009. [see statutory document] These however excluded all services provided by the NHS Direct NHS Trust, and have not been applied by the many Hospitals and other NHS bodies that continue to use 084 numbers [see my list).
Similar revisions to the terms of GPs' contracts, intended to come into effect on 1 April 2010, were also published. The relevant Statutory Instrument was however presented to parliament too late to complete its processing prior to dissolution, and no action has been taken to implement these changes. [see SI 2010/578]
Notwithstanding the preparatory work done so far, it will now fall to the government that emerges from the new parliament to take positive action to preserve the principles of the NHS.
In the absence of any indication of how NHS budgets will be protected when public spending is under pressure, we may wonder if payment by patients could be used as a way of achieving this.
- Talk of a "National Care Service", as part of the NHS, where the principle of payments by users is not ruled out, suggests the danger of a broader weakening of the principle of the NHS being exclusively funded by taxation.
- The "Big Society" appears to imply that people take care of themselves, making their own commercial arrangements with local providers, rather than relying on the government always footing the bill, or telling providers what to charge.
- Some would say that "fairness" is best achieved by patients making some financial contribution towards their treatment, or at least the associated administrative costs, rather than having these paid by others.
A few pence (or in some cases, pounds) on a telephone bill may not be the biggest issue in itself. It is however a clear manifestation of a principle that many hold dear being breached.
We are aware of NHS fees for prescriptions, eye tests and dental services. These are clearly stated, set nationally, explicitly sanctioned by parliament, and subject to exemptions loosely on the basis of need and ability to pay.
NHS service providers cannot be permitted to levy charges themselves (indirectly through use of revenue sharing telephone numbers in this case) under the terms of the NHS Constitution currently in force. One wonders if new circumstances and a possible new government will cause the fundamental principles of an aging institution to finally be formally abandoned in its 62nd year.
I propose a question to those seeking to take on the management of our NHS as members of the next parliament, and the government that emerges from it.
"How far will payments by patients be used to enable NHS budgets to be maintained in the context of public spending cuts?"
Any answer that falls short of a clear denial and an assurance that firm action will be taken to eliminate the existing examples of this practice must be taken as a commitment that sacrificing the principles of the NHS is a price worth paying for whatever else is to be done with public money.