Noel Plumridge on no-frills healthcare

A single fare from Leeds-Bradford airport to Dublin for St Patrick’s Day is currently a mere 99p. But do not for a moment think that is all you are going to pay. Add a fiver for online check-in, another fiver to pay by credit card and a tenner to take a bag, and your trip is already setting you back a little over 50 quid. Opt for priority boarding (£3) and text confirmation of your booking (£1), then rashly fail to print your own boarding card so it has to be reissued at the airport and that is an extra £40. Thankfully the suggestion of charging passengers for using the toilet during the flight remains, thus far, what might politely be termed pie in the sky.

The state pays for the no-frills service: the user pays for the optional extras

Then there is the near legendary Ryanair customer care experience. If you want to speak to a human being, here is an 0871 phone number (10p per minute). If you need assistance, here is an 0905 number (£1 per minute). And if you want to complain about Ryanair’s use of premium phone lines, feel free to call our 0844 number (5p per minute) and chunter away until you feel better.

What has the NHS to learn from any of this? A stay in an English hospital may be “free at the point of delivery”, but after the bold income generation initiatives of the 1990s people already pay plenty for car parking. Meanwhile, by maintaining a myth that mobile phones interfere with vital medical equipment, we have been able to rake in a few more pounds by charging patients for keeping in touch with their relatives. (The “medical equipment” in question being, it seems, mainly situated between nurses’ ears.) Television, madam? Kerching. A few entrepreneurial GP practices even tried the premium rate numbers wheeze for a while.

Actually there is plenty to learn. Ryanair is a hugely successful business in a ruthlessly competitive market. In an NHS pursuing scary levels of efficiency gain, Ryanair’s achievement of a 6 per cent unit cost reduction (excluding fuel) in the difficult trading conditions of 2007-08 might at least arouse some curiosity. Begin with a rather different philosophy of HR management and labour “flexibility”. They probably have decent costing systems too. Actually they would probably tell the NHS how it is done - for a price.

As for that “who likes Ryanair?” question, charging for services that have traditionally been part of the standard fare has also been striking a chord within the Conservative Party. In local government, Barnet Council is proposing to extend the “personalisation” of social care in a style closely based on the airline model, with prices transparent to service users. It is being unofficially termed “EasyCouncil”. Meanwhile a Conservative MEP, Charles Tannock, has called for a £10 charge for a GP appointment. Dr Tannock’s proposal was promptly dismissed by shadow health secretary Andrew Lansley. Yet both his and the Barnet Council proposals suggest a more radical strain of thinking emerging within the party.

In the context of government funded healthcare, the generic word for this approach is “co-payment”. The state pays for the no-frills service: the user pays for the optional extras. Not a “two-tier service” but, like Ryanair, a multi-tier service, with users constructing a package according to personal preferences - and, of course, ability to pay. In a cruel economic environment of public sector retrenchment, tax rises and increased borrowing, co-payment could prove attractive to a broader spectrum of political opinion.

A betrayal of core NHS principles? Something the UK public, used to a fully tax funded health system, would not countenance? Consider some recent statistics from the Organisation for Economic Co-operation and Development for the health spending of six western nations, split between public and private expenditure.

Did you know almost 20 per cent of UK healthcare spending is privately funded? That is curious for a system widely perceived as state controlled, and says much about the way we fund long term care of the elderly. Did you know that, even after all the growth in UK health funding since 2000, the much maligned US public healthcare system receives a greater share of national wealth (7.3 per cent) than the NHS (6.9 per cent)?

But what leaps out most is that advanced western societies seem willing to spend more of their wealth on healthcare: France and Germany each commit more than 10 per cent compared with the UK’s 8.4 per cent.

In principle this suggests there is considerable scope for growth. But funding such growth from taxation is inconceivable in the current political climate. Hence the growing attraction of a Ryanair approach, using co-payments and following precedents that have proved acceptable in other areas of society.

Unless, that is, you believe patients deserve what is good for them, rather than what they want.