Free NHS: have we reached the end of the road?

Last week we heard about the £30 billion funding gap faced by the NHS by 2020; this week the Royal College of General Practitioners (RCGP) informed us that the funding gap between 2013 and 2021 could lead to a shortfall of 16,000 family doctors in England.

In his blog last week, Chris Marsom asked how the NHS is going to address this funding gap. From using technology to drive efficiency, to generating income by exporting NHS services abroad and educating the general public about making appropriate use of the health service, he made some good suggestions.

Yet, I cannot help but feel that one key question has not been raised: in an era of austerity can a universal free health service survive? I know that I am touching a raw nerve by questioning one of the founding principles of the NHS, but as a French national (I know my name does not give this away) I am used to paying a contribution for access to first class medical services.

In its most recent major study of global healthcare systems, the World Health Organisation ranked France as best in the world. France has the fewest healthcare-preventable deaths among 16 OECD (Organisation for Economic Co-operation and Development) nations, waiting times for elective surgery are shorter than in England and the French have more doctors per 1,000 people. The reasons are simple: the French universal healthcare system is better funded.

Don’t get me wrong, I value and appreciate the excellent service I have, on the whole, received from the NHS over the past 20 years that I have lived in England. My point is, however, that if we want to continue receiving good care, one way or another, we may well have to pay for it.

Last year the Institute for Fiscal Studies and the Nuffield Trust jointly warned that the range of free services might have to be reviewed as the NHS face a decade of austerity until 2021.

As the types of treatments provided by the NHS are being rationed, waiting lists for referral or selective operations are growing longer, the standard of care in many hospitals across the country is rated as poor, we need to face the bare reality that it is clearly impossible to fund everything that people want and need.

I believe the NHS should consider a similar system to the French, where there are charges at the point of use that all but the poorest and chronically-ill must pay, such as a fee on GP visits. As well as funding the system, this should act as a deterrent for patients to consult their GP when not really necessary and address the issue of increasing patient demand.

This would be a politically courageous decision to be made by any government. The time is long overdue for a proper debate about what we can and cannot realistically afford to pay for on the NHS and who should pay for it.