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Health bill could herald a new wave of hospital charges

The NHS bill makes new charges more likely. How will this affect

The government puts a lot of faith in “patient choice” improving NHS care, but the government has to be very careful about what patients will make their choices on. They say that patients will make their choice on clinical quality, but that may not be the case.

One of the most contentious issues of the Health and Social care Bill is the current clause 12 (clause 10 in earlier versions of the Bill). This is the Secretary of State for Health “abrogation of responsibilities” clause. It says that the current duty of the Secretary of State, as outlined in section 3 of the NHS Act 2006, should be handed over to Clinical Commissioning Groups (CCGs). The original section in the 2006 act says that the Secretary of State must provide “to such extent as he considers necessary to meet all reasonable requirements” and then gives a list of services. One of these services is “hospital accommodation”.

In the past there has been discussion as to whether the NHS should pay for your so-called “hotel charges” when in hospital – for example, the cost of your meals and laundry. Some people argue that you would pay for your food if you are at home so why shouldn’t you pay for it when you are in hospital? This ignores the fact that patients have different dietary requirements to a healthy person. But more importantly, it ignores the issue of what happens if the patient cannot or will not pay the “hotel charges”: will they be denied the healthcare they need? Hospitals already charge for phone, TV and internet use, but these are services that can be regarded as optional and if a patient cannot afford these services they do not have to use them. Food, laundry and bed use as an admitted patient are not optional, without these services you cannot get your treatment.

Currently the Secretary of State makes a nationwide decision whether hospitals in England charge “hotel charges” and because they would be unpopular, no secretary of state has imposed such a charge. In the future a CCG could decide – due to financial pressures – that they will not pay for “hotel charges”. A CCG could argue that when facing NHS cuts such a decision would free-up resources to pay for much-needed healthcare. CCGs are not accountable, and cannot be voted out of office like politicians, so such unpopular decisions are much easier for them to make.

Such a decision would dissuade poorer patients from receiving care that they need. But it could also have an effect on patient choice. We know that hospital car parking charges are unpopular, but such charges are small compared with potential “hotel charges”. Given the choice of a hospital with high “hotel charges” and one with lower charges, patients will go to the cheaper hospital. Rather than choosing a hospital on clinical outcomes or waiting times, patients in the future may choose a hospital based on how cheap their “hotel charges” are. The effect will not be competition on clinical quality, but competition on laundry charges. Is this really what the government intends?

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

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