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NHS Bill lets GPs restrict treatment. So what happens if you can’t pay?

If Andrew Lansley were to make patients pay for blood tests there would be uproar. The NHS Bill lets him pass this decision to GPs.

Clause 10 of the Health Bill is a key clause in the Government’s plan to turn the NHS into a commercial market. In an earlier post for False Economy I said that one effect of this clause is to allow some Clinical Commissioning Groups (similar to the notorious GP practice in Haxby in Yorkshire) to restrict the services that the NHS will pay for so that patients will use their private practice. But what happens if patients cannot pay?

The Lords Select Committee on the Constitution says that Clause 10 of the bill will amend the NHS Act 2006 to say that a CCG must arrange for the provision of services “as it considers necessary to meet the reasonable requirements” of patients. The clause gives a comprehensive list of services including hospital accommodation; medical, dental, ophthalmic, nursing and ambulance services; services for pregnant and breastfeeding women; and diagnostics. In other words, almost everything the NHS currently provides is at risk. The phrase "as the CCG considers necessary" means that the CCG can decide what is, and what is not funded by the NHS, but the Bill does not say what will happen to patients that cannot afford to pay.

For example, at some time in the future your local CCG may look at its finances and decide that patients must pay for diagnostics like blood tests and x-rays. It is a local CCG that will make this decision, whereas at the moment it is the Secretary of State. If Andrew Lansley were to say "patients will now have to pay for blood tests" there would be uproar. Lansley would be hauled onto Newsnight or the Today programme to justify his decision. The political fallout would be huge and Lansley would rescind this decision. This is why we have politicians responsible for the NHS: they are accountable.

If a CCG says "patients will have to pay for blood tests", what will happen? The first time this happens the relevant CCG Chair will be hauled onto Newsnight to justify the decision. The Chair will say "we do not have enough money, we have had to prioritise". The Secretary of State will then make a bland statement like "NHS providers must cut bureaucracy and invest this money back into patient care" and shirk any responsibility. This first case will get a lot of publicity, and then our fickle media will ignore subsequent cases – and eventually the policy will be implemented throughout the country.

If CCGs pare down the services that the NHS will pay for it will result in patients having to pay. An honest Bill will make this clear. An honest and equitable Bill will have a clause saying that if CCGs bring in additional charges for care then there will be a mechanism to means test patients to ensure that the poorest get care even though they do not have the money to pay for it. This is not an honest Bill and it is not equitable. It is not even well thought out: there is no provision in the Bill to give care to those who cannot afford it.

In five years when there has been a political crisis from CCGs restricting care to those who can pay with no alternative for those that cannot pay, the government of the day will have to introduce another Bill to begin means tests and co-payment.

Richard Blogger writes about the NHS and social policy at NHS Vault.

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