NHS services are supposed to be free of charge – so why aren’t they?

When we think of what a fit for purpose health and care system could look like, what is our starting point?  If we try to answer this question from the perspective of people’s experience of accessing the system, there would no doubt be too many views to include in this blog.

Perhaps a starting point is one of the key principles that guide the NHS. The NHS constitution states that access to NHS services is based on clinical need, not an individual’s ability to pay. This means that NHS services should be free of charge, except in limited circumstances sanctioned by Parliament.  

But the reality for people accessing services does not necessarily match this definition.

For example, NHS dentistry is “hanging by a thread”, according to the British Dental Association. A BBC report reveals a desperate shortage of NHS dentists. Many are leaving the NHS to work exclusively in private practice – in the worst hit area, Portsmouth CCG, 26% of NHS dentists left over a period of 12 months. This is because the NHS dental contract penalises dentists for missing targets. 

As a consequence, people are resorting to DIY dentistry – one patient even superglued her own teeth back in. 

The reality is that certain parts of the NHS aren’t free in just “limited circumstances”. Even if you are lucky enough to be registered with an NHS dentist, you will still be charged £23.80 for basic care, including check-ups and emergency fillings.  

Similarly, prescriptions, though free in Scotland, Wales and Northern Ireland, are a hefty £9.35 an item in England, unless you belong to an exempt group. 

Eye appointments too cost at least £10, and a pair of spectacles will set most of us back at least £30. 

Poorer people have worse health outcomes

Technological advances mean the situation could get worse. For example, many optometrists now use optical coherence tomography (OCT) scans that can provide early diagnosis of many eye conditions – but they cost at least £25. Those who can’t afford a scan risk developing eye diseases that are treated late when they could be caught early. 

We already know that health outcomes are much worse for poorer people than wealthy people – the life expectancy gap between people living in the poorest and richest parts of the country is nine years. 

This isn’t what Aneurin Bevan envisaged when he set up the NHS, which was designed to offer free care irrespective of your ability to pay. In fact, he was so angry at the introduction of charges for prescriptions, dental examinations and spectacles that he resigned from the cabinet.   

Since then, the situation has only got worse. Good eye and dental care are not optional extras – they are an integral part of a person’s health and wellbeing. Indeed, there is a proven connection between gum disease and heart disease. 

We have to be more vigilant in resisting creeping charges for basic health care. To some extent, Wales, Scotland and Northern Ireland have shown the way in reducing or eliminating certain charges – perhaps it is time for England to follow suit.