History of health and care funding reform in England

A brief history of health and care funding reform in England

2013The Social Care ActResponse 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.
2011Prescription charges
abolished in Scotland
2011The Cancer Drugs Fund
Cancer Drugs Fund - £200 million a year for cancer drugs in England not yet approved by NICE, for provision on the NHS.
2010Prescription charges
abolished in Northern Ireland
2010Coalition Government Spending ReviewThe 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”
2009The Gilmore ReviewThe Review examined ways in which medical exemptions from prescription charges could be extended to include all those with long term conditions.
2009Extension of prescription
charge exemptions to
include cancer patients
2008Introduction of top up chargesPatients allowed to pay for additional private treatment and drugs without losing their NHS treatment.
2007Prescription charges
abolished in Wales
2006New 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.
2004Chargeable bedside
televisions and telephones
introduced to some hospitals
2002Wanless ReviewReview 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.”
2000The NHS plan The plan states that charges are “inefficient and inequitable”.
1999The Royal Commission on Long Term CareCommission 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.
1999Free sight tests (voucher
system) extended to those
over the age of 60
1998The National Institute
for Health and Care
is established
NICE is established to assess the cost-effectiveness of new drugs and technologies at a threshold of £30,000 per QALY.
1998Comprehensive Spending
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.
1997-2008NHS spending rises from £33 billion to £111 billion, in cash terms, the largest increase in its history
1988Free sight tests abolishedVoucher system exempts those on low income, children and with certain medical conditions.
1980-2001Maximum dental charge
rises from £30 to £360
The cost of a maximum patient charge rises five fold in real terms.
1979-1997Rapid rise in prescription
Prescription charges rose from £0.20 to £5.65. This was an 11 fold increase in real terms.
1979Royal Commission on the National Health Service 1979The 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.
1976-85Optical charges double in real terms
1975Prescription 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.
1971Charges introduced for
wigs and fabric supports
1968Prescription 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).
1968Health Services and Public Health ActExpanded local authority power to provide social care services. Provision of domestic help became mandatory and charges could be made for these services.
1965Prescription charges
1956The Guillebaud ReportThe 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
1952Prescription charges
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.
1951Charges for dentures and spectacles introduced
1949The NHS is given the
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