NHS should charge for services says ex-minister

Elderly people could be asked to pay for some NHS services such as non-emergency GP appointments in return for greater state support for social care, one of the architects of the Government’s care reforms has suggested.

Lord Warner, the former health minister who was a member of the Dilnot Commission which designed the new cap on the cost of social care, said politicians were more afraid to face the possibility of charging for treatments than the public themselves.

The Labour peer was speaking as the health think-tank the King’s Fund launched a new commission to look into ways of finally merging the health and social care systems.

The commission, to be chaired by the economist Kate Barker, has been asked to go “beyond Dilnot” examining whether the post-war settlement – in which health is provided by the NHS but social care by councils – should be torn up and redrawn.

Two former health secretaries, Labour’s Alan Milburn and the Tory Stephen Dorrell, spoke at the launch of the new commission, urging it to design a model to finally integrate the two services.

Mr Milburn said that the financial crisis had brought the “good times” in which health and social care spending continued to grow “to a juddering halt”.

In a scathing assessment of the current arrangements, he said: “It would be hard to invent a system which was less financially efficient or less focused holistically on the needs of the individual user.”

But Lord Warner warned the meeting in London that the question of who pays for care had been “skated over” for too long.

He urged the commission to look at whether the model designed by the Dilnot Commission – which involves means testing care but also capping the cost – could be applied to some parts of the health service.

He said it should be considered as part of a wider integration between the two systems.

He said: “I think we’ve actually created an architecture which I hope the new commission would feel free to use in terms of entitlement – moving ‘trade’ across the boundary, that’s free currently to the area where it is potentially means tested but it is capped.

“I think the bottom line in all this is that if we really want to integrate the services it is very difficult to see in the foreseeable fiscal future that you can load more into the NHS.”

He added that only a “supreme optimist” would believe that simply streamlining the NHS and cutting costs would be enough to pay for the growing demand it faces as the population ages.

Lord Warner explained afterwards that areas which could be looked at included some services provided by GPs.

But Mr Milburn, who is the Coalition’s social mobility tsar, said that there might be “no go areas” in public opinion including charging for things which are currently free.

He added that the current system breaks “all the laws of modern economics and modern industry.”

He argued that unlike with mobile phones, computers or cars, which have become cheaper over time despite getting more sophisticated, health and social care was still not able to “do more with less”.