How much can YOU pay? A&E charges would speed NHS privatisation

Health-CARE? It seems increasing number of GPs want the person on the stretcher to stump up a fiver or a tenner before the medical staff in the photograph can begin treatment.

Health-CARE? It seems increasing number of GPs want the person on the stretcher to stump up a fiver or a tenner before the medical staff in the photograph can begin treatment. (Image: BBC – intentionally left fuzzy to preserve anonymity of those involved)

It is strange that more has not been made of the revelation that one-third of GPs apparently believe a £5 or £10 charge should be imposed on everybody turning up at hospital Accident and Emergency departments.

This seems to be a clear next step towards the marketisation of what used to be the National Health Service, disguised with a claim that it would “reduce frivolous use of the NHS and the growing pressure on emergency departments”.

It seems that a poll of more than 800 doctors found 32 per cent said “fees would be the most cost-effective way of cutting the number of people who go to A&E, who could have gone to their GP or a pharmacist instead or did not need medical attention at all”. Presumably they have already tried simply telling people what to do, then.

The story in The Guardian states that “specialists believe between 30 per cent and 40 per cent of all visits are unnecessary and that many patients could have sought help elsewhere because their illness was minor or not urgent”. That leaves 60-70 per cent of visitors paying extra for services their taxes have already funded!

According to the book NHS SOS (edited by Jacky Davis & Raymond Tallis; published by Oneworld), the plan is to convert the publicly-funded nationwide health service into one of “managed” care along the lines provided by Kaiser Permanente in the USA.

This is based on a flawed use of figures (p.39) so Kaiser is in fact far more expensive, but that didn’t stop then-Department of Health strategy director Chris Ham from defending the claims and allowing Kaiser to emerge as the model for NHS reform. This was seen as particularly useful for those with cash to invest in the company or other MCOs (Managed Care Organisations) as they reaped huge profits – until market saturation, government and employer schemes to keep health care costs down, and a series of scandals made the pendulum swing the other way. Then these companies started lowering patient benefits, increasing premium fees and withdrawing from unprofitable markets, and this is very similar to the current situation in England.

Finally, these firms began to expand internationally, to countries including the UK, where the NHS was seen as a hugely attractive business opportunity.

MCOs decide how services are organised and funded for their clients, through contracts with selected providers and rigorous control of hospital admissions. This seems uncannily close to the work of Clinical Commissioning Groups, which were set up under the pretext that they would allow GPs to control budgets, but in practice allow the money to be controlled by private firms that have been hired by overworked doctors – as was always intended by the Tory-led Coalition government.

Government regulations mean private companies must be allowed to bid to provide as many services as possible. Freedom of Information rules mean they can find out how the public service operates and then undercut its bid. Without funding, the public service will close, leaving the way clear for the private provider to pump up its prices – so they will eat up more and more of the limited NHS budget. But which services do they choose?

They choose those that are easiest and cheapest to provide – the services that provide the most opportunity to make a profit.

Accident & Emergency is not one of those services. It will remain with the public sector providers who are being “continuously cut and squeezed into downsizing, mergers, centralisation and closures”, reducing care to “short-staffed, overloaded, ‘centralised’ units”, covering “only those services that the private sector does not wish to provide” (ibid, p.18).

How can services like A&E continue, if the private operators are taking all the cash? The only answer, it seems, is to bring in health insurance. That is the plan, at least – and the proposed A&E charges seem intended to be a palatable way of opening that door to a public that would once have treated the very idea as anti-British and voted the government that proposed it out of office for a considerable period of time.

Next it seems likely that “top-up” insurance will be offered to people whose complex ongoing conditions qualify them for so-called Personal Care Budgets. The budget money will be limited, forcing patients (or rather, customers) to “top them up” with insurance.

Be very clear on this: You are not looking at the thin end of the wedge. The wedge has already been driven in and England is well on the way to having a privatised health service, with the NHS as nothing but a brand under which taxpayers’ money can be handed out to private firms that handle only the simplest procedures.

The intention, it seems clear, is to allow publicly-funded services to wither over a period of time, in order to soften you up – make you more receptive to the idea of paying for healthcare that once was free but may not even be available in the future if you don’t come up with some cash.

Are you going to sit there and wait for that to happen? Private health care, and health insurance, is far – far – more expensive than the NHS, which was the most cost-effective and efficient health provider in the world until the Tory-led Coalition got hold of it. Don’t believe the propaganda – the service had record satisfaction levels in 2010.

You can still stop the rot. To find out how you can work to reverse the damage being done to the most cherished organisation in the UK, visit and

If you’re living in Wales, Northern Ireland or Scotland, don’t think that devolution of healthcare will save you because it won’t. Budgets are already under pressure from Westminster and the Tories will do whatever they can to force regional governments into the same, or similar, patterns.

One of life’s certainties is that you will become ill at some point. Don’t wait until that happens, because it will be too late.

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  1. Smiling Carcass January 5, 2014 at 1:27 pm - Reply

    Any payment beyond your taxes and National Insurance immediately removes the principal of an NHS- and I include prescription charges in this.

    “Free at the point of delivery” is a principal we must adhere to strictly or lose our NHS.

  2. […] via How much can YOU pay? A&E charges would speed NHS privatisation. […]

  3. Smiling Carcass January 5, 2014 at 1:48 pm - Reply

    Reblogged at SMILING CARCASS’S TWO-PENNETH with the above comment and a slightly modified picture.

  4. John Keen January 5, 2014 at 1:49 pm - Reply

    STOP STOP STOP saying that health care is free, IT IS NOT FREE, can you say NATIONAL INSURANCE?… the entire reason you PAY national insurance is to cover unemployment, illness and accident. it was setup as a compulsory payment to be paid by ALL those that are liable for income tax. IF, as it is clearly intended, that health care is to be privatised (and it is obvious to anyone with the slightest sense it will be by the conservatives) then it would make National insurance a fraud. Ofcourse it could always be renamed jobs tax….er….actually i do beleive that has been used as a desriptor for it already…..

    Income tax is NOT used to pay for wealthcare, Infact even National Insurance is siphoned away from it.

    What can you expect from a public that allows the Masters of Embezzlement to help themselves time and time again,
    Make no mistake the actions of the conservatives ARE those of Masters of Embezzlement.

    Note how they make the public concentrate on “ooh look a monkey dancing with a camel” and whoosh another Government department/utility sold off!… easy..

    Her Majesty the Queen had best beware also, since the Royals are considered an asset to the country then it’s not inconceivable that they could be on the list for privatisation.
    NOTHING is beyond the conservative mind where personal profit is concerned.
    Just think of all that lucrative land and buildings just waiting to be “realised”.

    • Mike Sivier January 5, 2014 at 2:16 pm - Reply

      I didn’t say healthcare is free.

      Apart from that, good comment.

      • John Keen January 5, 2014 at 2:26 pm - Reply

        Sorry not aimed at you Mr Sivier but the at those who believe it is.

  5. Joseph Smith January 5, 2014 at 2:13 pm - Reply

    I agree in principle with SCs comments above, however many people go to hospital because it’s damn difficult to get an appointment with a GP. Especially if the appointee needs an appointment at fairly short notice. However, personally, I won’t pay I’ve paid unwillingly and somewhat resentfully NI over a 43 year working life. So the idiots proposing this have my cordial invitation to go feck themselves with something Rusty and pointed.

    • John Keen January 5, 2014 at 2:29 pm - Reply

      Utilising a good sized pineapple should have the desired effect i think.

  6. Nick January 5, 2014 at 2:28 pm - Reply

    if you just turn up at A and E then you should pay as that is not the correct procedure
    the correct procedure is to be triaged by NHS direct or by 999 in an emergency in which you would not have pay

    personally i would make it £50 for just turning up to instil on the public the CORRECT procedure

    • Mike Sivier January 5, 2014 at 2:45 pm - Reply

      Oh really? I’m opposed to any form of on-the-spot payment as these people will have paid already via NI/taxation.

    • Smiling Carcass January 5, 2014 at 3:06 pm - Reply

      Really, Nick? And if you don’t have the money, cannot afford to pay? If your child is ill and you believe seriously ill, as has happened when my kids were little, and A & E
      tell you not to worry, it’s just a chill, or on swallowing a coin they tell you to wait until it passes naturally and to come back if there are any symptoms, in other words, this isn’t an emergency and doesn’t need treatment, but you genuinely believe it to be so? Do we pay then?

      And if we decide certain ‘conditions’ are not emergencies and should attract a fee, where do you suggest we draw the line; at the doctor’s discretion; the manager’s discretion or a nurses; and will that not create a system where there is a difference in the service you receive dependent on your location? In other words, not a National Health Service. (The clue is in the name.)

  7. Nick January 5, 2014 at 2:39 pm - Reply

    also i should just add that a walk in NHS centre should be chargeable as that is more inclined to be of a personal private preference

    like all things in politics a better balance along with common sense creates a much better country that can be seen to be credible across the world

    • Mike Sivier January 5, 2014 at 2:47 pm - Reply

      No! That would be a PRIVATE health centre! If people wanted to go private, they had that opportunity BEFORE all the current changes, and there was no reason to mess with the NHS.

      • Nick January 5, 2014 at 8:07 pm - Reply

        you cant just walk in mike that’s never a way forward in any country even a private person cant do that despite that market has grown in London

        those places are normally run by very inexperienced people and i certainly would never use one

        you must have good discipline in yourself to put others first at all times like i have always done and even thou i am ill i still put others first at all times and always have done

        whenever i have been admitted to hospital it’s always because i have followed the correct procedure and that will always be the case and for these people like myself following the rules should not have to pay but for everyone else yes they should as it mucks up the smooth running of a & e department to a level the staff cant cope with with most attending that are not in need of a a&e department but a pharmacist or their own GP out of hours service

      • Mike Sivier January 5, 2014 at 9:44 pm - Reply

        I’m not saying that anybody should be able to just walk in, though, am I? I’m saying they shouldn’t have to pay.

        If they are refused service and sent back to their GP or pharmacist, they DEFINITELY shouldn’t have to pay!

        A commenter on Facebook (I think) suggested that doctors should be fined if people are forced to go to A&E because the wait for an appointment at their GP surgery is prohibitively long. How do you feel about that? It seems like a sensible idea, since it seems to be GPs who are causing people to burden A&E.

    • Smiling Carcass January 5, 2014 at 3:09 pm - Reply

      Of benefit; to whom, Nick? Those that have money to pay? As Mike says, that’s private health care, the option being already available.

  8. George Berger January 5, 2014 at 2:40 pm - Reply

    Good grief, Mike. This may be off-topic or it might help indicate an international trend. Several weeks ago Edith Schippers, Dutch health minister. revealed that the Dutch private insurers (healthcare in NL was privatised on 1 January 06) will pay GPs a bit extra, if they cease treatment of cases they deem hopelessly terminal (supposedly after discussions with the patient). The GPs have long wanted this, since (they say!) this time is wasted and they are not paid for it. The sole Seniors’ organisation there. approves. I will add that the GPs make more money, the insurers save cash and the government saves on subsidies normally given to hospitals. The hospitals make more money (they’ll all be privatised soon, some are now), as their beds rotate more frequently.

  9. […] How much can YOU pay? A&E charges would speed NHS privatisation. […]

  10. beastrabban January 5, 2014 at 4:15 pm - Reply

    Reblogged this on Beastrabban’s Weblog.

  11. MrChekaMan January 5, 2014 at 6:34 pm - Reply

    This government is salami slicing our NHS to take it away from us bit by bit, and as such should be booted out of office. If it was up to me no MP or members of the House of Lords would be allowed to go private. Then they would have to look after the NHS. Don’t get me wrong, I don’t hate private enterprise which is good at a lot of things. It should just be kept out of things where a) people can’t do without it and b) there is either a monopoly or a de facto cartel pushing up the prices.

    • Smiling Carcass January 5, 2014 at 10:04 pm - Reply

      Well said, MrChekaMan.

      If they had no choice but to use the NHS, they’d soon sing a different tune.

      My own opinion is to outlaw private health care, which, despite the arguments to the contrary Bevan should have done, way back when.

  12. Mike Sivier January 5, 2014 at 9:45 pm - Reply

    Interesting comment from Andy King on Facebook: “I think there “might” be a correlation between the introduction of the new “non-emergency” phone number and an increase in “unnecessary” visits to A&E. Why? Because those calls are taken by non-medically trained staff who have no choice but to tell the caller to go to hospital. All part of the plan.”

  13. crisismaven June 19, 2014 at 5:47 pm - Reply

    I doubt it is really that easy to compare e.g. Kaiser Permanente and the state-run British NHS. To do that one would have to look at each and every line item and compare costs. Health care costs generally are higher in the US than in Britain so you’d have to adjust for that. But since both systems, in the USA as well as in the UK; are not a market economy but heavily, heavily regulated (even before Obama’s “reform”), you do not have market prices to compare. So any comparison makes no sense. And since you cannot have a health care market besides a statist setup side by side in the SAME country, you can never ever compare these systems. So any argument drawn from such numbers is essentially propaganda, no matter who uses it.

    • Mike Sivier June 19, 2014 at 6:02 pm - Reply

      Interesting argument – shame it’s come a little late for this article. My answer is that I can only go on the information available to me at the time of writing, and that information came from UK healthcare professionals who should know what they’re saying.

      • Nick June 19, 2014 at 6:30 pm - Reply

        you should not just walk in and expect that is never normal what i have said here is correct

        whenever i have been admitted to hospital it’s always because i have followed the correct procedure and that will always be the case and for these people like myself following the rules should not have to pay but for everyone else yes they should as it mucks up the smooth running of a & e department to a level the staff cant cope with with most attending that are not in need of a a&e department but a pharmacist or their own GP out of hours service

        anyone who attempts to not follow the correct procedure before attending a&e should have to pay as by just turning up unannounced that can cause a staff member to make a error on a patient that they have been treating leading to their death

        by all means do use a&e in an emergency but also make sure that you or someone close to you has dialled 999 so that they can let the hospital concerned know that you are on your way

        the bottom line is to show some respect for others and not just yourself

  14. Nick June 19, 2014 at 7:58 pm - Reply

    sorry mike :oops:

  15. Nick June 19, 2014 at 8:03 pm - Reply

    the bottom line is the NHS works the best in the world if only the likes of myself would or could run it

    my ENT surgeon said that would be wonderful if i could but sadly even if i were fit i still wouldn’t be able to run it as those types of positions are only ever given out by word of mouth or wealth by those in the know and with myself being of an independent nature (I’m in no ones pocket) rules it out

    • Mike Sivier June 19, 2014 at 9:14 pm - Reply

      That’s absolutely right – it’s like what I said about offering to put myself forward as a replacement for Ed Miliband’s useless ‘advisors’; I wouldn’t even be considered for it because I’m not one of the inner circle – even though membership of that inner circle instantly means you’re part of the problem.

      • Nick June 19, 2014 at 9:31 pm - Reply

        that’s always been the case mike those that could make a real difference not only at home but worldwide never get the chance

        we need to change the way the minds of people think but in reality when you look at the world today everyone is just looking out for there own and making a complete hash of it

        as your fit mike yes i think you would be a good advisor for ed and for no other reason is that you have a blog and contribute to it not only that you get others also on board which it’s what its all about the sharing of knowledge

        ed has no blog or follows blogs so has to stay in the dark at all times rendering him useless as he wont get to know anything where at least you mike have a very wide range and fight your corner but also admit if a better way comes along

        • Mike Sivier June 19, 2014 at 11:00 pm - Reply

          I’m glad you’ve noticed that.
          Yes, it’s a hard thing for anyone to do, but I’ve always tried to be open to the possibility that I’m not right about everything!

          • Nick June 19, 2014 at 11:22 pm

            you don’t have to right about everything only balanced and some good old common sense it’s not hard and it’s a pity the government lack both

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