A brief history of health and care funding reform in England
| Year | Reform | Detail |
|---|---|---|
| 2013 | The Social Care Act | Response to Dilnot Commission proposal to cap individual lifetime contributions to care costs. Lifetime social care costs capped at £72,000 from 2016 and the increase of the capital threshold for Local Authority funding from £23,250 to £123,000. |
| 2011 | Prescription charges abolished in Scotland | |
| 2011 | The Cancer Drugs Fund introduced | Cancer Drugs Fund - £200 million a year for cancer drugs in England not yet approved by NICE, for provision on the NHS. |
| 2010 | Prescription charges abolished in Northern Ireland | |
| 2010 | Coalition Government Spending Review | The Government announces that it will not include additional long term conditions in the medical exemptions from prescription charges as recommended by the Gilmore Review “in light of the challenging financial context” |
| 2009 | The Gilmore Review | The Review examined ways in which medical exemptions from prescription charges could be extended to include all those with long term conditions. |
| 2009 | Extension of prescription charge exemptions to include cancer patients | |
| 2008 | Introduction of top up charges | Patients allowed to pay for additional private treatment and drugs without losing their NHS treatment. |
| 2007 | Prescription charges abolished in Wales | |
| 2006 | New dental contract with revised system of charges. | Dental charges simplified into three bands of charges according to the complexity of treatment. The maximum patient charge for treatment was reduced from £384 to £189. |
| 2004 | Chargeable bedside televisions and telephones introduced to some hospitals | |
| 2002 | Wanless Review | Review flags the need for a very substantial increase in resources for health and social care. It concluded that “private funding mechanisms tend to be inequitable, regressive (those with greater health needs pay the most), have weak incentives for cost control, high administration costs and can deter appropriate use.” |
| 2000 | The NHS plan | The plan states that charges are “inefficient and inequitable”. |
| 1999 | The Royal Commission on Long Term Care | Commission recommneded that care costs should be split between living, housing and personal care. Personal care should be free on the basis of need and funded by general taxation on a pooled risk basis. Other costs should be means tested. Did not accept the "demographic timebomb" argument. Recommended setting up a National Care Commission to monitor trends, spending and standards. |
| 1999 | Free sight tests (voucher system) extended to those over the age of 60 | |
| 1998 | The National Institute for Health and Care Excellence is established | NICE is established to assess the cost-effectiveness of new drugs and technologies at a threshold of £30,000 per QALY. |
| 1998 | Comprehensive Spending Review | Review examined alternatives to the current system of health charges, and the savings/costs they would entail. The alternatives considered included a reduced prescription fee with fewer exemptions, charges for pensioners with income above a certain level, free dental checks for the over-60s and free sight tests for all. It was decided to make no changes to the existing system. Prescription charges were to rise by no more than the rate of inflation for three years. |
| 1997-2008 | NHS spending rises from £33 billion to £111 billion, in cash terms, the largest increase in its history | |
| 1988 | Free sight tests abolished | Voucher system exempts those on low income, children and with certain medical conditions. |
| 1980-2001 | Maximum dental charge rises from £30 to £360 | The cost of a maximum patient charge rises five fold in real terms. |
| 1979-1997 | Rapid rise in prescription charges | Prescription charges rose from £0.20 to £5.65. This was an 11 fold increase in real terms. |
| 1979 | Royal Commission on the National Health Service 1979 | The Commission concluded that while there are concerns for growing costs, including an ageing population and the rising cost of technology, the NHS was not in danger of collapse. |
| 1976-85 | Optical charges double in real terms | |
| 1975 | Prescription charge exemptions widened | The exemption for children is raised to 16 and for women is reduced to 60. Introduction of free contraceptive drugs and appliances. |
| 1971 | Charges introduced for wigs and fabric supports | |
| 1968 | Prescription charges reintroduced at higher rate | New exemptions for chronic medical conditions which were easily recognisable, lifelong and life threatening, requiring regular medication. The list has not changed since. Introduction of Prescription Prepayment Certificates (PPCs). |
| 1968 | Health Services and Public Health Act | Expanded local authority power to provide social care services. Provision of domestic help became mandatory and charges could be made for these services. |
| 1965 | Prescription charges abolished | |
| 1956 | The Guillebaud Report | The Committee was established in 1952 to examine the rising cost of healthcare and whether new cost containment measures or sources of revenue needed to be found. The report concluded that the cost of the NHS was rising largely due to inflation. Expenditure had fallen as a percentage of GDP. There had been a rise in the cost of drugs and more were prescriptions were being issued. A restricted list was rejected |
| 1952 | Prescription charges introduced | Introduction of prescription charge of 1 shilling per prescription form (5p). In 1956 extended to 5 pence per prescription item. Exemptions were introduced for those in receipt of National Assistance, War Disability Pension, children under the age of 16 or at school and venereal disease patients. Flat rate of £1 for ordinary dental treatment. |
| 1951 | Charges for dentures and spectacles introduced | |
| 1949 | The NHS is given the power to levy a charge for prescriptions | The measure was described by Prime Minister Attlee, “as a deterrence against extravagance, rather than as an economy.” |
| 1948 | National Assistance Act: The separation of health and care. Abolition of the Poor Law | Older and disabled people are divided into the sick who are placed in hospital and those needing “care and attention” who are placed in residential homes. Whilst the NHS provides services free at the point of delivery, local authorities can levy means-tested charges for residential and community social services |
Table based on The cost of our health: the role of charging in healthcare Thomas Cawston and Cathy Corrie Reform November 2013