Patients would be charged £8 a day when in hospital under proposals from a former health service boss to raise more money for the NHS.

Prof Stephen Smith is also urging ministers to bring in charges of £4 to £8 to help cover the costs of medical equipment that patients need, such as hearing aids and walking devices.

People over 60 should also start paying for their prescriptions, to help raise more revenue for an underfunded NHS that is under “unsustainable” pressure from rising demand, said Smith.

Rising public dissatisfaction with the health service and patients’ unprecedented waits for GP care, ambulances and routine operations mean ministers need to urgently instigate a review of how the NHS is funded, which should include the creation of “co-payments” for some services.

Smith, the former chair of the East Kent acute hospital trust, has set out his ideas in a new book published by the thinktank RadixUK. Its trustees include the ex-Conservative health secretary Andrew Lansley and the Labour MP Stephen Kinnock.

“I think the public would be prepared to pay some additional charges,” said Smith, who has also served on the boards of the Great Ormond Street and Imperial College Healthcare NHS trusts in London. Means-testing would ensure the poor were not affected unfairly, he added.

People should pay a fee of £8 for every day they are in hospital receiving medical care or undergoing rehabilitation, up to a maximum of 28 days a year, added Smith, who said his idea was based on the system in Germany, where patients are charged €10 a night.

More money could also be raised for the NHS through financial penalties for abusing the NHS by repeatedly missing appointments, a hypothecated tax to bring in extra income for the NHS and social care, and tax breaks for high earners who take out private medical insurance.

However, Dr John Puntis, the co-chair of the campaign group Keep Our NHS Public, accused Smith of advancing “harebrained ideas” and “zombie policies” which would end the basis on which the service has operated since its creation in 1948, including that it is paid for by general taxation.

“Charging people to cover part of the cost of a hospital stay would be a fundamental departure from the founding principles of the NHS and show that the longstanding consensus on a tax-funded public service model of healthcare has been truly abandoned,” said Puntis.

The government should instead generate more money for the NHS through capital gains tax, corporation tax and taxing private wealth, financial speculation and tax-dodging, he added.

Smith’s ideas come days after the head of the Royal College of GPs warned that family doctor services are under such strain that patients may have to start paying for them, in the same way that most already pay to see a dentist.

Prof Martin Marshall said: “We’ve ended up in a place where there is a very inadequate safety net [dental] service for those who can’t afford to pay and the majority of people do pay for their dentistry care. Could general practice go that way? It could do.”

Axel Heitmueller, a senior fellow at the Tony Blair Institute for Global Change and author of a recent report on the NHS, warned against co-payments. They “are effectively a regressive tax” which are expensive to operate, deter poor people from seeking care and do not reduce the demand for medical help, he said.

Politicians risk experiencing a “high political price for little actual gain” by ushering in charges because of resentment among voters, most of whom think that higher taxes are the best way to invest bigger sums in the NHS.

The Department of Health and Social Care declined to comment.

The headline of this article was amended on 25 July 2022. An earlier version stated incorrectly that the ideas were set out in a report.


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