Call for £20 patient fee to see NHS doctor

• Picture: Getty/ThinkStock

In a paper published yesterday, Professor David Bell, adviser to Holyrood's finance committee, says ministers should consider charging hospital fees of up to 20 per visit, to raise as much as 300 million a year for the NHS in Scotland.

Prof Bell, one of the country's foremost experts on the public finances, warns there is still a "widespread lack of public appreciation" about the scale of the crisis about to hit public services.

In a critique of the Scottish Government's preparations, he says further delays in setting out plans to combat the measures will more likely lead to "rough justice", with poorer families suffering the most.

His intervention came as finance secretary John Swinney confirmed he is to open talks with Scotland's 32 councils about ending the three-year council tax freeze from next April. Only this May, Mr Swinney told the Scottish Parliament ministers "certainly" intended to keep the freeze going.

However, since then, council chiefs have issued stark warnings about the state of their books, and say they may have to increase council tax in order to balance their finances.

Ministers, however, have held back from specifying what services or jobs will be axed next year, claiming they cannot act until Westminster provides them with exact figures on how deep the cuts will be.

• Professor David Bell suggests radical solutions are needed to plug funding gap Picture: Getty

In his new report to MSPs, Prof Bell says the situation is so grave ministers need to look further than areas already identified for savings, including at the NHS. Earlier this summer, the Independent Budget Review group suggested ministers should consider reversing some of the "free" benefits handed out since devolution - such as free personal care.

However, in his report, Prof Bell questions why ministers should sink policies introduced in the wake of devolution. "An alternative to reintroducing charges for personal care might be to extend charging in the NHS," he says.

He recommends Scotland follows the Swedish example: user charges in its health service provide about 3 per cent of the total health budget.

He adds: "Hotel charges for hospital stays and other charges in Sweden provide what would be the equivalent of 300m to the Scottish health budget." This figure is similar to the annual sum spent on free personal care.

If Scotland followed Sweden's lead, patients would pay between 5 and 20 for a visit to a doctor or a stay in hospital. Fees in Sweden are capped at about 80 for any single year.

Speaking to The Scotsman, Prof Bell said: "If you spend your time focusing just on the things that have happened since devolution, and roll back all the things that have happened since (such as free personal care], then you have to ask what is the point of going through all that exercise. We should look at other things that pre-date devolution. Charges for the NHS would be means-tested so those who can afford it contribute the most."

He warned the lack of firm plans in Scotland on combating the cuts was leaving the public sector with a "dreadfully short" period to make preparations.

He also says in his paper that taking Scottish Water out of direct ministerial control - thereby saving 140m a year - might be "irresistible" once spending cuts bite. He suggested ministers follow the example of Wales, where Welsh Water is run as a public company.

His report goes on to declare that exempting the NHS from the worst of the cuts would favour the elderly at the expense of the young.

"Youth unemployment is at record levels and the young have a low demand for health care. Yet the ring-fencing of the health budget will mean that even less support will be directed to this group, increasing intergenerational inequity," he says.

But health economists gave the plans for NHS charges a lukewarm reception. Professor Alan Maynard, of York University, said: "Certainly it is an obvious way of raising revenue and it is also likely to have a deterrent effect. But it is essentially a tax on the ill. And while you may get fewer people with trivial illnesses utilising the service, they may only then come back a few years later with a more serious illness which is more expensive to treat in the long term.

"And if many people are exempt from charges, it basically hits middle-class people the most."

Scotland Patients Association chair Margaret Watt said: "Imposing charges is not the way to do it. A lot of people don't have enough to feed themselves, so if charges like this were brought in, people would not have the money to go to see a doctor and get help with their conditions.

"It would put public health at risk and if people didn't go to see a doctor, their condition could get a lot worse and it would end up being more expensive."

SNP ministers also said they were opposed to the idea. However, they are facing growing questions about how they intend to meet the unprecedented challenge of finding the necessary cutbacks. Officials expect a total of 4.3 billion will be cut from the Scottish block grant in 2011, 2012 and 2013.

Mr Swinney told MSPs: "Our preference, as a government, is to retain the council tax freeze at a time when many households are still feeling the effects of the recession. However, we acknowledge there are a range of views and we are consulting accordingly, particularly with our local authority partners."

He also said the government was committed to cutting the number of public bodies and has a target of 1.6 billion in efficiency savings in the current year. "We will need to have further and more acute public sector pay constraints, given that 60 per cent of our cash costs are in staff salaries," he said.

Exact details will have to await the draft budget, to be published later this year, but opposition parties criticised the continuing uncertainty over the cuts, with both Labour and the Lib Dems urging ministers to lay out their budget plans immediately.

A spokesman for Mr Swinney said: "The Independent Budget Review is helping shape the debate surrounding Scotland's future spending. The SNP government is engaging with opposition parties, organisations and the people of Scotland to help determine spending priorities. We won't know just how bad the Westminster cuts to Scotland's budget are until next month when George Osborne announces the spending review, but we have already said any Barnett health consequentials will be applied to the NHS in Scotland, we will maintain the existing eligibility for free personal care for the elderly and concessionary travel, and maintain Scottish Water as a publicly owned company."

He added: "We are completely opposed to the idea of charges for NHS services."

Swedes have to pay but costs are capped

Patients in Sweden are required to top up health care costs every time they use the service.

The system was introduced in the 1970s after the country decided to introduce a national health service.

Prior to that, patients had to pay a far larger portion of the costs of their health care.

The fees were kept because ministers feared that, without them, demand would inevitably increase. However, they were reduced.

The top-up costs were a way of telling patients that their care was not completely free.

Within this system, plenty of patients still get a "green card" exempting them from any payment - such as those over the age of 65.

Fees are also capped annually, preventing exorbitant fees for anybody.

Consequently, polls have shown that very few people have been put off seeking medical help on the grounds of cost.

But, by having the fees, the Swedish government argues that it does restrict demand from getting completely out of hand.

In the UK, however, the NHS was formed on the principle of being free at the point of use - meaning that anyone can walk into a hospital and be guaranteed treatment without any cost.