I wholeheartedly agree with my hon. Friend. We delivered the highest levels of patient satisfaction in the history of the national health service. Now patient satisfaction is at its lowest level since at least 1997. There is a second basic promise of the NHS which, if it is not broken, is under attack today like it has not been for years. When I went through my treatment for kidney cancer I had lots to think and worry about—every cancer patient does—but the one thing I never had to worry about was the bill. That is the thing that people love most about the national health service, but those who have never believed that healthcare should be provided to all, regardless of their means, are using this crisis to attack that principle. The right hon. Member for Gainsborough called the NHS the
“the last example of collective planning and socialist central control”—[Official Report, 22 September 2022; Vol. 719, c. 840.]
and even today called on the Health and Social Care Secretary to look at insurance based systems instead.
The hon. Member for Christchurch (Sir Christopher Chope) has a Bill before the House this week that would extend user charging. The Prime Minister himself pledged last summer to charge patients who miss GP appointments, although he has since ditched that pledge—indeed, he has ditched an awful lot since he became Prime Minister. Two former Health Secretaries have joined in. The right hon. Member for West Suffolk (Matt Hancock) has proposed charging for missed GP appointments. The right hon. Member for Bromsgrove (Sajid Javid) went further and suggested charging patients to see a GP, or even to attend A&E. If he were here, I would happily give way to hear an explanation as to how that would work. The most deeply cynical thing about this, is that the right hon. Members for West Suffolk and for Bromsgrove are the people who bear much of the responsibility for the mess we are in today. They ran down the NHS. They refused to train the staff needed to treat patients on time. Now they say that timely care, free at the point of use, as we enjoyed 13 years ago, and as we have enjoyed for much of the past 75 years, is no longer possible—that we cannot afford it any more, that it is not achievable. That regressive, miserabilist argument cannot be allowed to win. Not only is it unjust, but it is wrong, so let us take it on in its own terms.
Why do patients who are ill enough to need to see a doctor miss appointments? Very often it is because the appointment clashes with work, they are unable to
travel, they did not receive the letter, or it arrived too late. The answer is to change the archaic and maddening way that patients are forced to book appointments, and build a new system around patient convenience. If patients could choose whether to have an appointment face-to-face or over the phone, if they did not have to wait on hold at 8 am to book an appointment, then wait for a call back that can come at any time of the day, fewer appointments would be missed. Why is it that those who attack NHS managers as being wasteful bureaucrats want to install far more of them? Because that is what an insurance-based system would mean. One-third of US healthcare costs go to insurance company overheads and providers billing patients. Is that really what the proponents of an insurance system want—more administration, more bureaucracy, and less money spent on delivering healthcare?
What would happen if we charged patients to see a GP? People would stay away. In some cases, yes, that would mean people who did not need to see a GP would not take up an appointment. But it would also mean that many people who needed to see a GP but could not afford the price stayed away. More conditions would go undiagnosed, and left to become more serious until the patient had to go to hospital instead. It would mean worse outcomes for patients, a less healthy society, and greater cost to the taxpayer. While we might save £39 on a GP appointment, it costs far more for patients to go to A&E, which costs £359 on average. Not only are those proposals unfair, but they would mean more bureaucracy, more late diagnosis, more expensive and less effective hospital treatment—exactly the opposite of what the NHS needs. Such proposals are wrong on fairness, wrong on efficiency, and wrong on health outcomes. Those in government have no plan for the NHS, and there are even worse ideas sitting on their Back Benches.