Report / Royal Commission on the National Health Service.

  • Great Britain. Royal Commission on the National Health Service.
Date:
[1979]
Catalogue details

Licence: Open Government Licence

Credit: Report / Royal Commission on the National Health Service. Source: Wellcome Collection.

    25/510 (page 11)
    A service free at the time of use 2.12 Charges for services within the NHS have always been a matter of controversy, and have ied on occasion to the resignation of ministers. We discuss charges in Chapter 21, but there are three points to be made here. First, the purpose of charges may be to raise revenue, or discourage the frivolous use of the service, or both. Second, charges may be made for a service which, though provided by or through the NHS, is not essential to the care or treatment of patients — for example, amenity beds in NHS hospitals. Third, in any consideration of charges, it is important to stress that “free at the time of use”’ is quite different from “free”. We do not have a free health service; we have a service to which all taxpayers, employees and employers contribute, regardless of the use they make of it. The effect of this is that those members of the community who do not require extensive use of the NHS help to pay for the care of those who do. It is worth remembering that about 60% of the total expenditure of the NHS goes on children, the old, the disabled, the mentally ill and the mentally handicapped. Satisfying reasonable expectations 2.13 This objective can be considered from the point of view of the individual patient, or more generally. Most patients lack the technical knowledge to make informed judgments about diagnosis and treatment. Ignorance may as easily be a reason for a patient being satisfied with his treatment as for his being dissatisfied. One aspect of care on which he will be reliable, however, is whether he has been humanely treated. While doctors are properly deferred to as experts on the technical aspects of medicine, options, when they exist, should be carefully explained and wherever feasible the choice of treatment left to the patient and his relatives. Maximum freedom of choice seems to us an important aspect of this objective although we recognise that there may sometimes be practical limitations on complete freedom of choice for patients. A patient, or potential patient, who is capable of deciding for himself, should be free to: consult a doctor, dentist, or other health professional; change his practitioner; choose a particular hospital or unit with the help of his general practitioner; and refuse treatment or advice except where the health or safety of others would be endangered. 2.14 More generally, it is important for any health service to carry its users with it, given that it can never satisfy all the demands made upon it. It is misleading to pretend that the NHS can meet all expectations. Hard choices have to be made. It is a prime duty of those concerned in the provision of health care to make it clear to the rest of us what we can reasonably expect. A national service responsive to local needs 2.15 Health services meet different situations in different parts of the 1]