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Opinion

Should patients be charged £10 for non-urgent A&E treatment?

Will paying for A&E treatment deter time wasters or prevent vulnerable people from accessing life-saving resources?

In January 2014 Doctors.net.uk surveyed its members on how they thought the NHS should ease the burden on accident and emergency facilities.  One third of respondents supported the idea of charging patients five or ten pounds for unnecessary visits.

This response sparked a heated debate in the healthcare community: would a charge deter time-wasters and free up resources for patients in genuine need? Or would it prevent people from accessing life-saving services?

Those in favour of a charge argue that it would cut down on visits from patients with minor problems, saving resources for those in urgent need, and preventing people from using A&E as a backup when their GP surgery is closed.

“Most believe that charging for A&E would be unethical and would prevent the most vulnerable members of society from accessing medical care”

The average GP appointment costs the NHS £25, whereas the average A&E appointment costs between £59 and £117.

Some argue that a charge would help to offset these costs and encourage people to choose their services more carefully.

They argue that, since there is a penalty for the misuse of emergency alarms on public transport, and for hoax calls to the emergency services, why not for unnecessary visits to A&E too?

However, most believe that charging for A&E would be unethical and would prevent the most vulnerable members of society from accessing medical care.

It is easy to see how a charge would discriminate against the homeless and the unemployed; but what about those who are able, but not necessarily willing to pay?

Many of us know someone, perhaps an elderly friend or relative, that watches every penny and wouldn’t dream of ‘wasting’ £10 on A&E - and wouldn’t make that life-saving phone call. Then there are the administration costs involved in setting up a charge system. But above all, charging patients for A&E would go against the core principles of the NHS, which says ‘Access to NHS services is based on clinical need, not an individual’s ability to pay.’

Perhaps the answer is not to charge patients, but to educate them, as is the focus of the NHS’s current Choose Well scheme.

Choose Well is designed to increase the public’s awareness of the different healthcare services available, and may already be having a positive impact. Data from the Health and Social Care Information Centre suggests that the problem of time-wasting may have been exaggerated when, in reality, patients are getting better at choosing emergency services.

Over 90 per cent of A&E attendances in 2011/12 had a valid treatment code – an 18.2 percentage point increase on 2010/11. Setting up a charge system, and all the extra administration it would create, would be the real waste of NHS resources.

Overall, it seems that a move towards charging for patient care would be a dangerous one – not only for the NHS as an institution, but for the patients it serves. While time-wasting should of course be discouraged, only by helping patients to make better decisions can we ensure that A&E is always there for those that need it.

 

Vikki Geary is a writer that works with NHSTaxRefund.co.uk.

 

Readers' comments (7)

  • I can see the appeal, but those most likely to 'abuse' A&E will be from groups that would be exempted from the charge. If a charge is to be levied, it would have to be much greater than £10 in order to offset the costs involved in recouping it.

    You can't really blame patients from turning up at A&E when they are unable to be seen by their GP in an acceptable time frame.

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  • No, until you are prepared to provide a decent globalised service! there are better and far more suitable ways of reducing the number of patients attending A&E. Why put them under strain when often they see no other alternative. Besides, how would you decide who, and who not to charge? Alternatively reduce taxes or offer a tax rebate instead of expecting patients to pay twice!

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  • Please remember there are out of hours GP services and if people use 111 properly and they are advised to go to A&E they should not be penalised.
    In Hertfordshire the 111 service is working very well, people need more information in the media and advertised in prime locations to encourage and inform them to use this service.
    The introduction of clinical navigators in A&E depts.will stream patients to the correct services.

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  • Virginia, I'm glad the 111 service and out of hours GP works well in Hertfordshire, but please don't assume that's the same in every area! We had a nightmare trying to get someone to see my 88 year old mum one weekend, 111 were hopeless and in the end after a 10 hour wait a locum GP travelled 40 miles to see mum. He said we should have phoned an ambulance - sometimes you cant win!!

    We need to ensure there is good quality out of hours care available to all, then we should start to see A&E being used by the right people.

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  • it is very poor show and disgraceful that healthcare professionals familiar with the services cannot get those they need either.

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  • Dear Sarah,

    Yes I agree. I am aware that other areas are sufering with 111, I just hope that if one area gets it partially right then other areas might look at that model and follow.We do have to percievere with this system. Unfortunately at the end of the day unless you have some medical knowledge we are all at the mercey of the system.
    I have allways held the view that in cases of illness if in doubt shout.
    I would sincerely hope that anyone with chronic illness or the elderly should be treated empathetically in a casualty department.
    All these documentaries on TV about emergencey work unfortunately never really drive it home about the time consumed with non emergencey complaints.

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  • "I have allways held the view that in cases of illness if in doubt shout."

    look what happens to the poor unfortunate patients who shout!

    http://www.telegraph.co.uk/health/healthnews/10700256/New-claims-of-patients-locked-up-at-NHS-hospital.html#comment-1287292635

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