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| Version 1 | Version 2 |
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| Call for hip and eye op charges | Call for hip and eye op charges |
| (about 1 hour later) | |
| NHS patients should be made to pay for care, including hip and eye surgery, in a similar way they do for dentistry, NHS public health chiefs say. | NHS patients should be made to pay for care, including hip and eye surgery, in a similar way they do for dentistry, NHS public health chiefs say. |
| The Association of Directors of Public Health said rising demands on the NHS will lead to more rationing. | The Association of Directors of Public Health said rising demands on the NHS will lead to more rationing. |
| The association said emergency care had to remain free, but only patients with the most severe joint and eye conditions should get free operations. | The association said emergency care had to remain free, but only patients with the most severe joint and eye conditions should get free operations. |
| Officials said minor ops, such as for varicose veins, should not be done. | Officials said minor ops, such as for varicose veins, should not be done. |
| Doctors' representatives said more NHS care should be rationed, but they were against charging. | Doctors' representatives said more NHS care should be rationed, but they were against charging. |
| What is wrong with asking people to contribute for some care which is not life-saving - much as we do with dentistry? Dr Tim Crayford, of the Association of Directors of Public Health | What is wrong with asking people to contribute for some care which is not life-saving - much as we do with dentistry? Dr Tim Crayford, of the Association of Directors of Public Health |
| Dr Tim Crayford, president of the association, which represents NHS trust public health directors across the UK, said since 1998 spending on cataracts had increased by 40% to £200m, while the cost of hip operations had risen a third to £300m. | Dr Tim Crayford, president of the association, which represents NHS trust public health directors across the UK, said since 1998 spending on cataracts had increased by 40% to £200m, while the cost of hip operations had risen a third to £300m. |
| "What is wrong with asking people to contribute for some care which is not life-saving - much as we do with dentistry?. | "What is wrong with asking people to contribute for some care which is not life-saving - much as we do with dentistry?. |
| "Emergency care would remain free, but for operations such as cataracts and hip operations we need to decide at what point in people's lives these operations should be done. | "Emergency care would remain free, but for operations such as cataracts and hip operations we need to decide at what point in people's lives these operations should be done. |
| "If the public agree a threshold what about people below the threshold? Our argument would be that below that threshold they should be allowed to contribute towards the cost as they would with a filling. | "If the public agree a threshold what about people below the threshold? Our argument would be that below that threshold they should be allowed to contribute towards the cost as they would with a filling. |
| "The thing with hip and cataract ops is that they have become more common as waiting lists have fallen and surgery improved, so we have to ask ourselves is it better if patients are asked to wait until their level of pain or blurred vision is more acute. | "The thing with hip and cataract ops is that they have become more common as waiting lists have fallen and surgery improved, so we have to ask ourselves is it better if patients are asked to wait until their level of pain or blurred vision is more acute. |
| "The NHS will not be able to do everything in the future." | "The NHS will not be able to do everything in the future." |
| Benefit | Benefit |
| Dr Crayford also said the health service was currently carrying out some care which had little medical benefit. | |
| He said procedures such as certain types of plastic surgery, orthodontic surgery, and varicose vein surgery should not be provided in the future. | |
| "As the elderly population grows and more medical breakthroughs are made, it is clear we are going to have to think about what the NHS is there for and what it is providing." | |
| In the end it is going to have to be decided by a public debate and it will be the public which should decide what the NHS does Nigel Edwards, of the NHS Confederation | In the end it is going to have to be decided by a public debate and it will be the public which should decide what the NHS does Nigel Edwards, of the NHS Confederation |
| The British Medical Association is currently drawing up proposals about what the NHS should be providing and will discuss the issue at its annual conference later in the year. | The British Medical Association is currently drawing up proposals about what the NHS should be providing and will discuss the issue at its annual conference later in the year. |
| Jonathan Fielden, chairman of the BMA's consultants committee, said it was an important debate. | Jonathan Fielden, chairman of the BMA's consultants committee, said it was an important debate. |
| "We are already rationing the procedures we do, cosmetic surgery is not carried out on the NHS, and the drugs which are used are restricted. | "We are already rationing the procedures we do, cosmetic surgery is not carried out on the NHS, and the drugs which are used are restricted. |
| "And I think there is scope to include other things such as varicose veins and hernias in that. | "And I think there is scope to include other things such as varicose veins and hernias in that. |
| "But the question is how far do you go? If you include hips and eyes I think you are breaking with the traditional values of the NHS, I wouldn't agree with that." | "But the question is how far do you go? If you include hips and eyes I think you are breaking with the traditional values of the NHS, I wouldn't agree with that." |
| But Professor John Appleby, chief economist at the King's Fund health think tank, said: "I do not buy into these doomsday scenarios. How much extra demand is there going to be on the NHS? | But Professor John Appleby, chief economist at the King's Fund health think tank, said: "I do not buy into these doomsday scenarios. How much extra demand is there going to be on the NHS? |
| "I don't think there are any miracle drugs in the pipeline and as for the people living longer, what matters most is how close you are to death, not how old you are. | "I don't think there are any miracle drugs in the pipeline and as for the people living longer, what matters most is how close you are to death, not how old you are. |
| "We consume the most health resources in the last year of life whether that is at 50 or 80." | "We consume the most health resources in the last year of life whether that is at 50 or 80." |
| Professor Appleby also said it was likely there would be public appetite to increase the amount spent on health to keep pace with increasing demands. | Professor Appleby also said it was likely there would be public appetite to increase the amount spent on health to keep pace with increasing demands. |
| Nigel Edwards, director of policy at the NHS Confederation, said: "The issue is quite rational; after all, care is already rationed and we already make a contribution to dentistry, but it is a very emotive and political subject. | Nigel Edwards, director of policy at the NHS Confederation, said: "The issue is quite rational; after all, care is already rationed and we already make a contribution to dentistry, but it is a very emotive and political subject. |
| "In the end it is going to have to be decided by a public debate and it will be the public which should decide what the NHS does." | "In the end it is going to have to be decided by a public debate and it will be the public which should decide what the NHS does." |