Means Testing Health Care

Means Testing Health Care

One of the founding principles of the NHS, and surely its greatest feature, is that it is free at the point of delivery regardless of ability to pay. This was a remarkable experiment, built out of the ruins of two world wars, the experience of the Great Depression, and the realisation that a substantial majority of the population could not afford to pay for health care. If you really want to know how it was, read the novels of A.J. Cronin.

This great experiment started with the idea that, as the backlog of ill health was dealt with, the costs would reduce and the population would get healthier. Nobody could have foreseen the enormous burgeoning of new treatments, the major successes in treating acute disease that resulted in rapidly falling death rates, an ageing population, a huge increase in chronic disease management and the enormous rise in demand for health care. Remember, in 1948 antibiotics were in their infancy; we knew precious little about genetics; babies born before 7 months gestation were pretty much written off; there were no ventilators to speak of (remember the iron lung?); and women still regularly died in pregnancy and childbirth. And out of all this ill health and sadness grew our magnificent experiment.

The Labour Party has always tried to claim it as its own, but that is a re-writing of history. The reality is that all major parties had a hand in designing and delivering it. And while my own profession was not totally on side (the BMA opposed it, to its shame) many doctors and most other health professionals did support it.

And now this great force for social good is under threat. The Health and Social Care Bill, if enacted, will drive a coach and horses through the NHS. Some aspects are being hived off to Local Authorities, together with entire Public Health departments. These include services for women and children, sexual health services, public mental health. Why should this be a cause for concern? What does it matter where these services are provided?

It matters profoundly, because ‘free at the point of delivery’ only applies to the NHS. As we are all too well aware, Local Authorities can and do means test their services. Once these services are LA provided, there is nothing to stop them being means tested. And that will have a terrible effect on the most disadvantaged in our society and will increase health inequalities. I can envisage a day when young people are means tested for all sexual health advice; when drug and alcohol services are means tested. What effect will this have on health inequalities?

This is turning the clock back. Do we really want that? As I said: read A.J. Cronin.