Lord Warner, Labour Minister for Health Reform under Tony Blair, says a £10 per person per month NHS membership charge and other patient contributions are necessary if the NHS is to survive the next five years of austerity.

Lord Warner is also calling for means-testing of NHS Continuing Care, which he says would save up to £4 billion a year, and for higher “sin” taxes on alcohol, tobacco, sugary foods, betting and gambling. And the NHS membership scheme - which would be collected with council tax to fund local preventative health care - should include an annual MOT for people of working age, to set new responsibilities each year for both the NHS and the individual, he proposes. 

NHS funding from general taxation should rise only with inflation to avoid starving the rest of the public sector of resources, says Lord Warner, co-author of a new report published by think tank Reform. It argues that tackling the “care crisis” requires the NHS to turn into a National Health and Care Service (NHCS), based on a new partnership between state and citizen, and under which services would be refocused on early intervention in the community for both managing chronic and mental health conditions and preventing illness.

The current health care delivery model, largely unreformed since 1948, “inflates NHS costs and limits many people’s potential to live longer and healthier lives,” say the authors. They call for virtually all current hospital sites to be preserved but with many refitted as primary care services, delivering integrated health and social care locally in the community, while hospital specialist services would consolidated “on fewer, more highly skilled, safer centres with 24/7 consultant cover.” 

“Even with major changes to care, it is now irresponsible to pretend to the public that current forms of taxation alone will be sufficient to provide a good-quality health and care system,” says the report. It calls for funding from general taxation for its proposed new NHCS to be frozen in real terms and for the Service to receive a 1% increase per year above inflation, funded not only from “tougher, hypothecated, inflation-proofed sin taxes” and means-testing for NHS Continuing Care, but also from: more people paying inheritance tax, so that a greater share of cost is borne by the wealth of older people rather than by younger income tax payers; inflation-proofing prescription and dental charges; “hotel” charges for overnight hospital stays; and full-cost holiday vaccination charges.