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Last Updated: Saturday, 13 August 2005, 14:36 GMT 15:36 UK
Top surgeon calls for NHS rethink
Insurance should part-pay for NHS treatment, said Mr Ribeiro
A tax-funded NHS, free at the point of use, is unsustainable, one of Britain's most senior doctors has said.

Bernie Ribeiro, the new president of the Royal College of Surgeons, said patients should be forced to pay part of the cost of treatment.

They would take out insurance to cover that, he told the Daily Telegraph.

But Unison, the UK's largest health union, said the public was "rightly proud" of the existing NHS structure and would object to such changes.

The social insurance system suggested by Mr Ribeiro would be similar to those in France and Germany.


"We will have to look hard at an alternative system," he told the Telegraph.

"If we are to provide healthcare free at the point of need all the time for patients, then I don't think that's achievable in the present structure."

We could afford our workers to make an identifiable contribution towards healthcare
Bernie Ribeiro
Royal College of Surgeons president
Mr Ribeiro argued that the rising cost of technology and medical staff would make a tax-funded NHS unsustainable in the medium term.

He said: "The working population is reasonably well paid, we could afford our workers to make an identifiable contribution towards healthcare - not one hidden in national insurance and taxation."

But contributions would be means-tested, with the poorest people required to pay nothing at all, he said.

He said the government needed to make some tough choices about what should be available on the NHS.

"I would prefer to say we will give you the best emergency care possible, but you may not get all the elective work you want done on the state," he said.

The government's position was outlined by Chancellor Gordon Brown in 2002, who said a tax-funded NHS was "demonstrably the modern rational choice".

"Unlike systems of charging, it does not charge people for the misfortune of being sick," he said.

Public pride

Unison strongly criticised Mr Ribeiro's ideas, saying one of the founding principles of the National Health Service - free treatment for all at point of delivery - should be maintained.

"The NHS is something the public is rightly proud of and I think any attempt to make people pay for their treatment would cause a public outcry," a spokeswoman said.

Unison said the money the government had put into the NHS was starting to show improvements, and questioned the use of the private sector in the NHS - " that money should be going into building up the NHS."

If healthcare is not sustainable by tax, there's no reason it would be sustainable by social insurance
Nigel Edwards
NHS Confederation

The NHS Confederation, which represents health service managers, said it was an "inescapable fact" that health costs across the world were rising faster than people's willingness to pay.

Policy director Nigel Edwards: "If healthcare is not sustainable by tax, there's no reason it would be sustainable by social insurance.

"The basis for social insurance is directly from people's incomes and is usually compulsory - that sounds to me like a tax."

Shadow health secretary Andrew Lansley said it was not necessary to abandon the concept of a tax-funded NHS, but reform was needed.

"The NHS requires not only taxpayers' resources but also reforms that bring patient choice, GP fund holding and competition amongst healthcare providers."

Liberal Democrat health spokeswoman Julia Goldsworthy said that while it was important to explore new methods of funding for the NHS, "we must ensure that healthcare is provided on the basis of need and not the ability to pay".

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