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Wednesday 26th October 2016

Palliative care and user charges

24th July 2008

Michael White writes in the Health Service Journal about palliative care and changes to the NHS.


I was reminded of the deaths of close friends when I contemplated the Department of Health's end of life care strategy.

The front of the document quoted Dame Cicely Saunders, who forged ahead in the hospice movement: "How people die remains in the memory of those who live on."

Dying, which was once so much more prevalent - even in the young - in that infectious age one hundred years ago, is now "largely a matter of old age and chronic illness. Familiarity has decreased."

We can improve how people die in their homes. Alan Johnson and the social care minister Ivan Lewis have increased funding for palliative care to £380m by 2010/11.

In comparison to the United States, where money and technology are used to try to stave off the unavoidable, the attitude in the UK is, as Niall Dickson of the King's Fund commented, related to "attitude and priorities."

Managing patient's pain in their homes is another key concern. This should be something that the "state, voluntary and even private sectors should be able to do more together than apart".

Charles Clarke, the former home and education secretary has written an interesting and challenging piece about how the cohesion of these sectors should form the basis of any future outlook for healthcare.

Mr Clarke wants to initiate debate about "user charges" as a way of ensuring the efficient and fair use of public services.

The idea of "user charges" includes a vast range of potential charges, from parking tolls to dental payments.

Mr Clarke insists that poor people would not suffer if such charges were used, if they were "protected".

He favours improvements to the insurance and co-payment systems to fund care for the elderly and other treatments.

Essential "core" treatments and care would not be charged for. However, non-essential treatments might be paid for because they are "clinically ineffective".

It's clear Mr Clarke is giving us the chance to debate the issue in a sensible way.


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