When Sir William Beveridge wrote his report on social insurance he identified five giant evils: squalor, ignorance, want, idleness and disease.
Squalor, disease and want were all inter-linked. Squalor meant circumstances where disease was rife and often untreated. Want was both created by and a sustainer of disease: want was at times a result of worklessness due to ill-health, and meant that that ill-health could not be treated as there was no money to pay for medical care, thus perpetuating the poverty trap.
At the time of Beveridge’s report, Britain fell short of other countries in only one area: medical care. Whilst the rest of social security or insurance was disjointed and inadequate, it still compared favourably with other countries. Medical care however did not compare well.
Beveridge proposed a new system that would be available to all regardless of class: Medical treatment covering all requirements was to be provided for all citizens, and rehabilitation treatment “for all persons capable of profiting by it.” Every citizen was to have access for “whatever medical treatment he requires, in whatever form he requires it, and to have access to “all necessary medical services, both general and specialist, domiciliary and institutional.” This is the NHS that Beveridge helped to set up: one that was paid for through contributions or taxes, and was fully available to all, ‘free at the point of use.’
He considered it a “logical corollary” that the State would want to reduce the number of people on incapacity benefits by ensuring a comprehensive health service – if the State helps people get better, it doesn’t have to pay them incapacity benefits. If the government did not pay directly for the disease or accident to be treated, then it would pay indirectly through reduced power of production; the individual would pay through loss of ability to work. There was therefore good economic reason for the government to provide a national health service.
There have been hints and suggestions that this may change. Doctors and MPs are mooting the possibility of charging for more services. But this surely goes against the fundamental principle behind the founding of the NHS.
Now I’m not a historian and I don’t know all the reasons or politics behind the start of the NHS. Nor am I an economist, so I don’t know all the capital costs and benefits of leaving someone to be ill versus paying for their treatment, recovery and return to work. But I’m fairly sure that if there were benefits in setting up a national health service then, there are benefits in keeping it now. If someone with the money to pay for treatment chooses not to, that is their choice (albeit with lost productivity for the State). But if someone who cannot afford treatment therefore doesn’t get any, that is a regression to a society not seen for seventy years.
Beveridge said that “restoration of a sick person to health is a duty of the State and the sick person, prior to any other consideration.” He also said “The Government should not feel that by paying doles it can avoid the major responsibility of seeing that … disease [is] reduced to the minimum. The place for direct expenditure and organisation by the State is in … preventing and combating disease.”
The State – this government – should not be considering removing ‘free at the point of use.’ The principle of providing ‘free’ healthcare (i.e., healthcare paid for by tax and/or NI contributions) is right. It is right for the government, who should not be paying incapacity benefits for people instead of paying for their healthcare; it is right for individuals who should not bear alone the cost of misfortune.
If charges are necessary – and I don’t run the NHS budget, so I don’t know – then it needs to be done very carefully. There needs to be complete consideration of the principle of the NHS – that people who can’t afford healthcare should not remain ill or unable to work for that reason. Any ‘core’ set of services needs to be based on this. And as Katherine Murphy said, “we do have to have a grown-up conversation with regard to co-payments and top-ups. But with scandal after scandal in the NHS the public wants us to address those now. Unless care is made better, we cut down on waste and the public sees the NHS putting its house in order I don't think it is the time for that conversation.”
Whatever is decided regarding charges, the end result should still be that no-one is ill because they are poor, and nor should anyone be poor because they are ill.
chief executive of the Patients Association, as quoted in the Guardian, 24th June