“The system of health charges in England is a mess.”
This statement summarises the situation facing not only the NHS, but also the public services of England as a whole. In a nutshell, the tightening of the fiscal purse strings in recent years has led to a drop in the funding available for public services. As a consequence, the coalition government has ultimately decided to directly cut the funding available for public services, which is more than likely to lead to reduced service quality. Yet a little known approach exists which may (with intelligent implementation) assist with the future funding of England’s public services. This approach is aptly named: user-charges.
On the surface, user-charging sounds like privatisation. However, what it aims to do is ensure a continuation of a public service in the face of budget cuts, rather than have the service terminated altogether.
User-charging for these purposes has already been put in place across England. Public swimming pools, for example, were faced with a decision a few years ago to either introduce user charges, or simply close shop. I am quite happy to be able get my towel, don my oh-so-fashionable flowery swimming shorts, and head down to my local pool, where I would have to pay a few quid, rather than not being able to swim at all.
The London Congestion charge, introduced in 2003 by then Mayor, Ken Livingstone, is a prime example of how user charges can be introduced to help support public transport. The price of the London Underground, which was listed as one of its major weaknesses in a 2009 report by Transport for London (TfL), has been kept under relative constraint due to the revenue generated from the Congestion charge. In addition to this, the Congestion charge assists with the continuing development of bus and rail services in London.
Thus, user-charging is already in place across England, so would it really be such a bad thing for this concept to be expanded? If done correctly, the answer is a resolute no.
The major concern, and quite rightly so, is about equity. The danger of user-charges is that it will result in those from lower income backgrounds being unable to afford the service if user-charges were in place. A consistently well-cited example is the NHS, where any introduction of private finance is seen as incredibly damaging. However, when discussing user-charges, it does not solely mean the individual. It can also refer to a business.
Without becoming side-lined about the various actors that exist within private finance, equity is an incredibly important issue. A Canadian study, conducted in 2001, concluded that, at the time of writing, there were failures within the charging mechanisms of the Canadian National Health Service which failed “to protect the poor … particularly in the area of equity”. This is a damning statement for user-charges, yet an in-depth analysis is needed, on a service-by-service basis, to determine which aspects of public service provision can be reformed to allow for user-charges.
This review, which must comprise of independent researchers, industrial experts and professionals, in conjunction with elected politicians (to ensure any reforms are legitimate), has to be conducted before any changes can be made. There can be no introduction of user-charges, or any form of privatisation for that matter, without a carefully thought out road map. I am not suggesting that I know the answer. I am however stating, quite clearly, that there must be a review of some sorts on how public service provision is financed in England (I leave out Scotland, Wales and Northern Ireland as, due to devolution, they can be treated as separate entities in regard to public service provision).
Without this review, you run the risk of creating an inequitable society, where the poorest in society cannot afford to pay for those services upon which they rely on for daily survival. I do not know the direction we must take if user-charges were to become economically, politically, and socially efficient, yet I do know that something must be done to ensure the continuation of our public services for all.
In the age of austerity, all options must be considered, and user-charges are one such option, However, any government must be careful to ensure they are introduced ethically. It remains to be seen if the current NHS and educational reforms will be anywhere close to ethical, let alone equitable.