Doctors reject extension of patient charges

British Medical Association conference: Leaders say extra NHS cash must come from public funds

Hospital waiting lists will rise to record levels this winter unless more money is found for the National Health Service, the British Medical Association warned yesterday.

There is a financial black hole at the heart of the NHS and an extra pounds 1bn a year is needed for the next five years if it is to continue providing a full range of treatments, doctors' leaders said. That is equivalent to an extra pounds 17 a year per head of population a year, or 30p a week, the price of a Mars bar.

Without extra funds there was no hope of the Government keeping to its election pledge to cut waiting lists by 100,000, the association's annual conference in Edinburgh was told yesterday. The meeting decisively rejected calls for an extension of patient charges and for an earmarked health tax, which is reported to be under consideration by Gordon Brown, the Chancellor of the Exchequer, under the "no holds barred" public spending review.

But the meeting agreed by a narrow majority of 142 votes to 128 to look for other sources of finance for the NHS.

The looming prospect of an NHS crisis was the only issue that galvanised doctors, who otherwise appeared content to wait and see what the new government would deliver. However, there were widely diverging views on how the shortage of funds should be tackled.

Dr Joan Black, of west Berkshire, said a feeling of desperation was overwhelming NHS staff struggling to maintain standards. At least 120 NHS trusts and 69 health authorities had begun the year in deficit and pounds 10bn was needed for capital repairs. "The shabbiest building in the neighbourhood is often the local hospital," she said.

Dr Jonathan Reggler, a GP in Buckinghamshire, said the nation faced three choices: to pay more in tax for the NHS, to raise more through patient charges or to do nothing "and watch the NHS die".

The public had demonstrated its reluctance to pay more tax by refusing to elect any government that threatened to raise tax rates and an earmarked health tax would do nothing to curb rising demand, he said. Charging pounds 10 for a GP or out-patient visit and imposing hotel charges for hospital stays could raise pounds 500m a year, half the total the BMA said was necessary.

"The NHS is evolving and the way we pay for it must evolve, too," Dr. Reggler said.

Other speakers dismissed the fatalism of those who argued that the country could not afford the NHS. Dr Peter Bennie of Glasgow, chairman of the junior doctors, said charging patients was like "putting a stake through the heart of the welfare state".

Dr Evan Harris, a former hospital doctor and Liberal Democrat MP for Oxford West, said NHS spending should be raised to the level of comparable countries. To cheers he added: "The BMA must put down a marker now. It must fight, fight and fight again for the NHS we love."

Earlier, Dr Sandy Macara, chairman of BMA Council, told the conference that extra money for the NHS should be provided "unequivocally and explicitly" from public funds. Speaking to reporters later, he said the conference vote in favour of examining alternative sources of finance was a purely tactical move, to prepare to combat proposals that might be put by the Government after the spending review. "You don't have the ammunition to shoot down mad ideas unless you have the evidence," he said.

The BMA has been looking at ways of raising money for the NHS since 1988 and had found nothing as fair, acceptable or efficient as direct taxation he said.

t Doctors at the BMA's conference voted unanimously yesterday to condemn the Government's "persistent manipulation" of their recommended pay rises. Another motion calling for the resignation of the chairman and all members of the independent Doctors and Dentists' Review Body was overwhelmingly rejected.