A Sick Proposal on the Health Service

The Social Market Foundation, a British political think tank, is proposing that a £20 charge should be payable for members of the public to see an NHS doctor. The proposal, it is claimed, is a response to the "financial crisis" facing the NHS in the coming years.

The proposal, which is of course not government policy at present, illustrates the huge gap that exists in Britain between those who make such proposals and those who would suffer their consequences should they be implemented.

Report author David Furness (pictured) is clearly immune from the pressure that such an outrageous move would have on low and middle income families. The report's recommendation that the charge should not be levied on "anyone receiving tax credits" is a typical piece of nonsense driven by people whose life experience of poverty appears to be acquired from studying statistics and calculating averages rather than from struggling to make a living in the world of low-paid work.

The report's statement that "A charge of £20 for GP appointments should be introduced to encourage healthier, wealthier people to avoid using the NHS except when absolutely necessary, with anyone receiving tax credits totally exempt" represents an incredibly naive perspective - dividing British society up as it does into the wealthy and those on tax credits.

As noted on Left Luggage in May, many poor parents register as self-employed rather than accepting what is described as "poverty pay" in clerical or manual jobs and, in doing so, make themselves illegible for tax credits or other forms of social security. Such low income families would, of course, still be required to pay the proposed £20 charge to see a GP.

Under the report's proposal, furthermore, middle-income families with children would find themselves hundreds of pounds out of pocket every year just for making an appointment with their GP, despite assurances that such charges would be capped at "around £100 per year" per patient. This is before the cost of any prescriptions and other charges and before the hidden cost of illness such as work time lost, travel costs to hospital or the "choice" of going private for major surgery.

When faced with the option of making such payments or risking their children's health, parents will do whatever they feel they need to in order to get the service they are being taxed to provide and will, if they cannot afford the £20 levy, will turn up at A & E centres in large numbers demanding to be seen by a doctor. Hardly an efficient use of public money.

Perhaps we should not be too surprised by the report's lack of rootedness in the real world. The Social Market Foundation is chaired by Lord (David) Lipsey whose statement in the House of Lords in 2001 on the crisis of capitalism seems rather apt under the circumstances:

"However, that does not mean that there will not be a crisis of capitalism. A different kind of crisis can come over an economic system: it is not so much an economic crisis as a moral crisis. It can occur when a system becomes so far divorced from the moral sense of the people who make it work as to become inoperable."
Hansard Feb 2001

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