WE’RE living in the age of weird.

Brexit, Covid, the war in Ukraine and populist Tory rule have created a Britain that would have seemed 15 years ago like a novelist’s satirical flight of fancy.

One impact is that we’ve all become accustomed to the abnormal. I don’t just mean wearing coats inside or cocking a bored eyebrow to hear the police are looking into another Prime Minister’s behaviour; I mean that in this skewed version of Britain we now inhabit, the poorly among us are getting used to triaging ourselves.

“Do not attend A&E unless it’s a genuine emergency,” we’ve been told ad nauseam in recent months. It doesn’t matter if you’re a data scientist, a retired janitor or a shop assistant, we all have to do our best doctor impressions and judge for ourselves if we’re sick enough to attend hospital. Is that abdominal pain anything to worry about? Is it OK for flesh wounds to go that colour?

We always have the wonderful NHS24 of course, but the choice of whether to attend casualty departments is ultimately ours and the message seems pretty clear: unless we’re having heart attacks or there is immediate risk to life or limb, pop a bit of Savlon on it and try the GP again in the morning.

Doctors and nurses’ leaders warned for years that the NHS was breaking, and now in the opinion of many, it finally has.

Politicians are to blame for dodging the difficult conversation about how sustainably to fund (and staff) the NHS when the population is ageing and treatment options proliferating.

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So let’s be magnanimous to Sajid Javid and say he’s trying to begin that conversation. The Tory former health secretary suggests that people could pay for visits to the GP (he cites the Norwegian example of £20 a visit) or to A&E (look! In Ireland they charge a “nominal” £66 if you turn up without a referral!)

He says the current model of British healthcare is “unsustainable” and talks about “protecting those on low incomes” (the Conservatives being so well known for that).

Downing Street responds that the Government is not “currently” considering the idea, a qualified statement that speaks volumes.

Well, we do need to think radical thoughts about NHS funding, don’t we? Yes we do, but there’s radical – and then there’s this. This isn’t just radical, it would effectively destroy the NHS as we know it. The NHS was founded and has operated for nearly 80 years on the principle that healthcare should be free at the point of delivery, providing equal access and quality of care to a countess and a cleaner.

Limited charging (the “contributory principle”, as Mr Javid euphemistically calls it) is not new – English patients pay for their prescriptions – but free access has always been preserved. Charging at the point of access would be like setting dynamite beneath its central pillar. It would be a health service, but not the NHS as we understand it.

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This would amount to a tax on the sick. It would be a capitulation to inequality. Charges for GP and casualty visits would put off people who should be seen by a doctor and the charge would be liable to increase when the public finances were tight.

“Protecting those on low incomes”: how? What would be the criteria? It would need an expensive bureaucracy to police it and collect the cash, so how much would really be saved? What would become of those who required regular contact with their GP or A&E department, such as the elderly, those with chronic conditions, pregnant women and families with young children?

The burning issue here is about fairness and whether people would still get timely medical help. How many would be deterred from visiting the doctor if they had to pay? We all know what impact a late diagnosis can have on cancer survival chances. Health inequalities, already scandalously wide, would only worsen.

These adverse human consequences are hardly the stuff of fantasy: they happen all over the world in systems where access to healthcare is mediated by credit cards.

Dr Ellen Welch, co-chair of the Doctors Association, wrote in Metro this week about her experience as a cruise ship doctor, where British passengers had to pay for consultations.

“I recall the elderly lady who shuffled to the nurse’s station on board the ship looking fairly well. She asked about the consultation fees and then decided against a visit,” she writes. “Twenty-four hours later the whole medical team was summoned over the Tannoy to her cabin, to find her in extremis from a condition that could have been prevented had we only seen her earlier.”

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A few years ago, a highly experienced GP told me that it’s often the third, fourth or even fifth thing patients mention to him that they are really worried about. First comes the sore throat, secondly the oddly-shaped liver spot, followed by the request for eczema cream and only then the unexplained lump, bouts of breathlessness or suicidal thoughts. Some people delay GP visits because they fear what they might discover, others don’t want to “bother” busy doctors. There is a well-documented problem of getting men in particular to seek medical help.

The last thing we should be doing is putting up financial barriers.

The writ of UK politicians does not run to Scotland’s NHS, but we ignore this debate at our peril. We’re naïve if we think this conversation in England will not impact the debate here.

Former Prime Minister Gordon Brown, writing in The Guardian, says the Tories are “testing the water for a different kind of NHS” in which private finance features. Brown would foresee under such a model the creation of a two-tier system in which the better off paid for private insurance. He warns that would be inefficient as well as inequitable.

Hospitals would run much more efficiently if we better funded and managed social care to prevent unnecessary stays in hospital and mass delayed discharge which creates queues at the front door.

So let’s have that conversation. Let’s consider a wealth tax or more cash for the NHS out of general taxation and national insurance. Let’s tackle the crisis in social care, but a till on the GP’s reception desk? Never that.