Image: Death of the NHS (after David). Rights: Peter BB Davis.

Imagine for a moment that you are the newly re-elected Conservative Prime Minister, and you want to launch an inquiry into whether the NHS should be paid for in future through user charges and insurance, not through tax.

But you’ve got a problem - you’ve just won an election without breathing a word that you were considering such a fundamental change to the funding of the NHS.

So how would you make such an announcement?

Very quietly, of course.

Last week the government did just that.

If David Cameron, or his Chancellor or Health Secretary had announced such an inquiry to re-consider a principle that has been sacrosanct since 1946, you’d expect front page headlines and Newsnight specials considering the implications. You’d expect a bit of a flurry (to say the least) about whether Cameron was back-tracking from his promises about what voters said was their number one issue.

But the launch of this inquiry has not been reported in the mainstream media, at all.

Why? Because it was casually announced by a little known minister, the newly ennobled “Under Secretary of State for NHS Productivity", Lord David Prior, in the rarefied atmosphere of a House of Lords debate on the “sustainability” of the NHS, moved on 9th July by crossbench peer Lord Patel.

The principle of how the NHS is funded has (mostly) stood firm since 1946, summed up in clause 4 of its White Paper:

“All the service, or any part of it, is to be available to everyone in England and Wales. The Bill imposes no limitations on availability – e.g. limitations based on financial means, age, sex, employment or vocation, area of residence, or insurance qualification.”

That is, the NHS is available to everyone, whether or not they can afford to pay user charges, or whether they are insurable. The question about whether the NHS could be funded through user charges or insurance is answered here: No it shouldn't.

But where better to have the sort of debate that no one has voted for, and launch an inquiry that no-one has voted for, than in the House of Lords, which no one has voted for?



Prior – recently elevated to the Lords from his stint as the strongly pro-market chair of the Care Quality Commission, formerly a Conservative MP and deputy party Chair – led for the government in the Lords debate.

Before he seized the opportunity to push his agenda, he said he listened to the “strength of feeling” in the unelected House.

Tory peers like Lord Cormack argued in favour of moving away from tax funding, saying:



"All forms of funding must be looked at. We have to have a plurality of funding if we are to have a sustainable NHS. Whether the extra funding comes from compulsory insurances or certain charges matters not, but it has to come.”

Matters not!? As a true Tory, he says that the funding should not come from taxing the rich (which he does not even countenance), but instead from taxing the sick.



More disappointing were the contributions from Labour peers like (the notoriously pro-privatisation) Lord Warner:

“Our tax-funded, largely free at the point of clinical need NHS is rapidly approaching an existential moment. The voices of dissent and outrage will no doubt be deafening but a wise Government should begin now the process of helping the public engage in a discourse about future funding of the NHS."

Far from endorsing the tax-funded system that is widely acknowledged to be the fairest way of paying for healthcare, here we have Labour peers suggesting the government should "help" the public to think of other ways to pay for healthcare.

Another Labour peer, Lord Desai, suggested bizarrely that patients should be issued with an "Oyster card" which is deducted whenever a patient uses healthcare, and patients should receive a "bill" at the end of the year, saying this would “help make it clear to people that a free National Health Service is not a costless one."

Shades of Jeremy Hunt's daft suggestion to put the price on prescription medicines.

But the problem with the NHS is not unnecessary demands, it is the sheer magnitude of people who need healthcare. An "NHS Oyster card" will not reduce the number of elderly people with acute co-morbidities. And if "consumer demand" is a problem, the solution is to turn patients back into patients rather than healthcare consumers, and remove the market.



Once their Lordships had had their say, Prior concluded for the government, saying that though he “personally” liked a tax-funded system,

“if demand for healthcare outstrips growth in the economy for a prolonged period, of course that premise has to be questioned."

And he announced the ‘way forward’:



"I would like to meet the noble Lord, Lord Patel, and maybe two or three others, to discuss this in more detail to see whether we can frame some kind of independent inquiry—I do not think that it needs to be a royal commission. We are not short of people who could look at this issue for us; there are health foundations, such as the Nuffield Trust and the King’s Fund.”

Prior ignores the fact that the Kings Fund has already recently carried out an inquiry, the Barker Review, which rejected user charges and called instead for more taxes to pay for healthcare, in particular through a review of inheritance tax and national insurance increases.

Both of which George Osborne has just cut, of course.

So Prior orders another inquiry, this time using people he has chosen and presumably people who will produce the desired result. Such a fundamental inquiry should involve the public and be held in public, but it appears Prior does not want the public involved.

Is Prior, in announcing an inquiry into so fundamental an issue, acting above his paygrade as an unelected junior health minister?

And are we being nudged towards an inefficient, unfair ‘pay NHS’ in the only way possible – undemocratically?

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Editors' note:

We've been inundated with people asking how they can help fight this. We suggest contacting your MP and pointing out to them that the government health minister, Lord Prior, has just suggested to parliament that he plans to launch an inquiry to consider whether we should move away from a tax-funded NHS towards one funded by insurance and co-payments.

Ask them (if they are a Conservative MP) or ask them to ask David Cameron in parliament (if they are not) whether it is now official government policy to consider such a move to an insurance or user-fee funded NHS, away from the core principles of the NHS that have been in place since 1946?

You might also want to remind them that David Cameron said in 2011:

'Let me make this clear - we will not be moving towards an insurance scheme, we will not introduce an American-style private system. In this country, we have this most wonderful, precious institution and idea. That whenever you're ill, however rich you are, you can walk into a hospital or surgery and get treated for free. No questions asked. No cash asked. I will never put that at risk.'

And ask your friends to do the same!