Demonstration in Tower Hamlets in January 2008 against the privatisation of GP surgeries
Demonstration in Tower Hamlets in January 2008 against the privatisation of GP surgeries

Plans to allow patients to pay directly for services could undermine equality in the NHS in England, create a new layer of bureaucracy, divert funding to unproven treatments, and result in some patients not getting the care they need, the BMA warned yesterday.

The Department of Health in England is currently exploring the possibility of ‘personal health budgets’.

One option would be for some patients, for example those with long-term conditions, to hold their own budget and pay directly for NHS services.

In its response to a government consultation on direct payments, published yesterday, the BMA raises concerns that:

• they would result in a new layer of bureaucracy and administrative burden on Primary Care Trusts (PCTs);

• they could result in an inequitable system that funds services or treatments for patients who hold a personal budget, but not for those who do not;

• in the event that a patient’s budget is held by a third party, there would need to be safeguards to prevent exploitation;

• a mechanism could be created to allow PCTs to refuse or ration further care to patients who had spent their whole budgets;

• allowing patients to have money ‘banked’ could encourage them to save it ‘for a rainy day’ rather than spending what they need on their care;

• the idea of healthcare simply as a commodity would be reinforced.

Dr Hamish Meldrum, Chairman of Council at the BMA, said: ‘We believe in choice and flexibility for patients but these plans are worrying for a range of reasons.

‘Apart from the practical difficulties and added bureaucracy involved, direct payments would take us even further towards a model where healthcare is a commodity to be bought and sold rather than something to which people are entitled.

‘These proposals potentially undermine the principle of equal access on which the NHS is based.’

A GMB spokeswoman told News Line: ‘The GMB supports the views of the BMA and have deep concerns for the government’s direction of travel, as “personal health budget” is simply another way of saying public sector funding goes into private sector hands.

‘The only type of organisations likely to fill the gap is the independent sector who will be providing services in direct competition to the NHS local authorities.

‘This is a policy decision that the GMB thinks should be reversed by the government.’

Anna Athow, Consultant Surgeon and BMA Council member said: ‘Patient budgets are a bad thing for all the reasons that the BMA outlines. They are designed to commodify healthcare and open the door for private companies to provide treatments that may or may not be effective or the best thing for the patient.

‘This is further evidence of the government’s drive towards a market in healthcare that is being rapidly pushed through and underlines the need for health trade unions and the whole trade union movement to get together and put a stop to it.

‘The NHS must be defended as a publicly provided service.’