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Charging is 'a mess'

18th July 2006

18072006_pharmacy1Q.jpgA report by the Commons Health Select Committee concluded that 'the system of health charges in England is a mess'.  MPs said that the National Health Service could be reduced to a package of core services, with charges for other treatments. They called for a review to look at this reform and the impact it would have.

The NHS Confederation in responding to the report, called for a national debate about how money is spent in the NHS, what patients can expect for free, and what can be charged for.

With an ageing population, demographic pressures, rising public expectations and medical advances "some treatments or procedures may have to be charged for", the committee said.  They warned that "in the future, the NHS may not be able to pay for every possible medical treatment". They called for the government to consider that possibility sooner rather than later so that a "consistent set of principles" could underly any changes, which would be a significant break with the postwar cross-party consensus over the NHS being largely free at the point of use. The committee suggested various options the review should consider, including a set of treatments for which the NHS could charge; a package of core services that would remain free; and charges for treatments judged not to be cost effective or, for example, where patients wanted branded drugs when non-branded ones were effective.

The committee also suggested a fee for patients who missed appointments, or a charge for attending accident and emergency departments in non emergency situations, in order to promote more responsible use of the service. They stressed that charges should not deter patients from seeking health care, and the principle should remain that "services that are clinically necessary should be free".

The review should also look at abolishing existing health charges, or basing charges solely on income. The committee stressed that medical exemptions from prescription charges was particularly confusing; the list of exemptions was complied in 1968, with the vast improvement in medical science since this time that was 'unacceptable'.

It recommended free hospital parking for patients who needed to attend daily and reduced charges for regular visitors. The cost of bedside telecommunications was also unacceptable.

Peter Cardy, Macmillan Cancer Support, Chief Executive said that "It is unacceptable for patients to pay hundreds of pounds in parking charges to attend hospital for treatment so the Committee’s recommendation for reduced, or free, parking charges is great news."

Dr Gill Morgan, chief executive of the NHS Confederation said that “NHS trusts have introduced initiatives to help patients with the cost of car parking. Many hospitals also have schemes for patients who are receiving ongoing treatment to ensure that they receive free or reduced rate car parking. Other trusts have set up park and ride schemes for staff which means more spaces are freed up for patients. It is important to understand that this is not about making a profit out of patients – it is about managing demand and covering the costs of maintaining a car park.?

A spokeswoman for the Department of Health said: "We will study the recommendations of this report carefully. We are absolutely committed to NHS treatment remaining free at the point of delivery."

The committee chairman, Kevin Barron, said that the work needed to be done "urgently".

The Full report of the Health Select Committee can be found at http://www.publications.parliament.uk/pa/cm200506/cmselect/cmhealth/815/81503.htm

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