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Give taxpayers the right to pay more into the NHS and access treatment where they like

Allow taxpayers to contribute more to NHS and access treatment where they like

  • Proposal to raise up to £3.5bn extra revenue by allowing patients to spend their budgets where they choose, inside or outside the NHS
  • A voluntary scheme that would make the NHS more responsive to demand and give patients more say in their treatment
  • Additional income would alleviate need for higher general taxes to pay for under-funded NHS

NHS patients should be given the opportunity to take their personal treatment budgets to any suitable healthcare provider in return for a modest additional monthly payment, a new Civitas report proposes.

The reform has the potential to raise billions of pounds a year to help plug the health service’s widening budget deficit and give patients more flexibility and control over where they are treated.

Patients would be able to spend their personal budgets in different parts of the NHS at no extra cost for standard treatments. They could also purchase enhanced treatments either from NHS foundation or trusts or even non-NHS providers if they were prepared to top up the sums they are entitled to under NHS tariffs.

This would mean they could avoid long waiting lists and congestion at individual hospitals, which would in turn experience less pressure on capacity and be able to operate more safely and efficiently.

The report’s authors, NHS consultant Dr Christoph Lees and Civitas researcher Edmund Stubbs argue that this would alleviate the current stress on the health service while raising much-needed extra revenue. Such a move would offset the need for higher general taxation or any extension of user charges to fill the black hole in the NHS’s accounts.

Their proposal is for a voluntary scheme allowing patients in England to see the benefit of their additional contribution while remaining true to the principles set down by Sir William Beveridge, whose vision of the welfare state paved the way for the NHS.

Lees and Stubbs write: “The proposed NHS contribution scheme would help safe-guard the NHS’s core commitment to meeting the needs of everyone.

“Where NHS services are known to be poor, the alternative of seeking treatment elsewhere will be available to patients. This is one means of challenging the existing ‘postcode lottery’ where patients have widely differing quality of NHS treatment in different areas of the country.

“Money raised from the contribution fee could then be invested in these weak or inefficient aspects of NHS service, improving the level of care for those who use them, even where they are non-contributors to the scheme.”

The authors also stress that it would avert the need for further reform of the NHS, which badly needs a period of stability and investment.

“A voluntary NHS contribution scheme would not in any way cause or require the tendering out of any services, or seek to change the current logistical structure of the NHS,” they write.

“It would simply act as an add-on; allowing individual patients who chose to contribute, an increased personal choice of provider instead of having to use those providers made available by the present block tendering out of services by commissioners.”

For membership of the scheme, dubbed “NHS Contribute Extra”, Lees and Stubbs propose a 0.5% income deduction direct from payroll (those on benefits would pay only 0.25%). This would amount to £100 a year for somebody earning £20,000 per annum and could raise up to £3.5 billion depending on how many people sign up.

After four consecutive monthly payments (to avoid individuals contributing only when anticipating illness), those who take part would be entitled to access their personal treatment budget. They would allow them to spend up to the value of the tariff that NHS commissioners have already set, obtaining standard services at no extra cost or topping up their allowance if they wish to purchase enhanced services from, for example, an NHS Foundation Trusts or an independent approved private provider.

It would enable many more individuals to access NHS treatment unavailable from their local provider as well as non-NHS treatment that would have previously been unaffordable to them. Theoretically, NHS referrals can already be made to anywhere else in the NHS free of charge, but in reality funding issues and administrative costs often prevent this from happening.

“Everyone would benefit because the availability of an additional, reliable income stream will give both NHS and private providers the confidence to increase their capacity,” Lees and Stubbs write.

“In particular, the additional income could encourage investment in separate facilities for elective procedures that are often cancelled at short notice when there is pressure on A&E departments.”

Contributors could also benefit from extras aimed at encouraging people to take more responsibility for their own health, thus helping to prevent lifestyle-caused illnesses. These extras would be in the form of vouchers offsetting the cost of gym membership, annual “health MOTs” where basic clinical measurements such as pulse rate, blood pressure and percentage body fat would be taken, and personalised targets for improvement or maintenance set in relation to age and physical condition.

Such measures would encourage contributors to become more involved in safe-guarding their own health and wellbeing. It is envisaged that different contributor packages could be offered depending on individual lifestyle preferences or even beliefs.


‘NHS Contribute Extra: A return to the NHS’s core values’ can be read in full below.

Christoph Lees is a Consultant in Obstetrics and Fetal Maternal medicine, Clinical Reader in Obstetrics at Imperial College London and a founding member of the Doctors’ Policy Research Group at Civitas. Edmund Stubbs is healthcare researcher at Civitas.

For illustrative purposes, NHS Contribute Extra would raise an extra £3.5 billion in England alone based on the membership of:

  • 50% of those earning under £20,000
  • 75% of those earning between £20,000 and £200,000
  • 50% of those earning more than £200,000
  • 75% of pensioners
  • 50% of those not needing to work (of independent means)

To raise £1.2 billion it would require the following levels of membership:

  • 25% of those earning under £20,000
  • 25% of those earning between £20,000 and £200,000
  • None of those earning more than £200,000
  • 25% of pensioners
  • 25% of those not needing to work (of independent means)


NHS Contribute Extra: A return to the NHS's core values

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