Uncovered McKinsey report challenged ‘free at point of delivery’ pledge

A report prepared by consultants McKinsey suggests politicians may need to “challenge the principle that the NHS is free at the point of delivery” in order to fund healthcare.

The report explores a number of options based on abandoning that principle including:

  • Patients paying to attend A&E 
  • Patients paying for access to primary care
  • Patients paying for inpatient stays
  • Enforcing tougher eligibility criteria for treatments, “e.g., hip replacements only for the over 80s, social care packages only for the acutely-ill, asking people who need it to buy their own equipment”
  • Means-testing patients
  • Denying “high-cost end of life treatments such as chemotherapy” and other treatments that are “high cost per Quality-Adjusted Life Year (QALY)”

The report, prepared for the NHS in Northern Ireland in 2010, was unearthed by Steve Walker. They are marked “solely for the use of personnel in the Health and Social Care Board and Public Health Agency of Northern Ireland” and it is stated that “prior written approval” would be needed for wider circulation.

It appears to have been published online at an address which is not accessible from any other webpage on the same site and not listed in any site index. However, the agencies Age NI and Social Care Online have linked to it in the past.

McKinsey have been closely involved in the Government’s health reforms, and accused of having a conflict of interest in its involvement with private healthcare firms and contracts with GPs. In February last year the Daily Mail reported that it had used its access to share information with private hospital firms.

In its report, the firm outlines further strategies in addition to the options for charging patients or restricting access to elements of healthcare. These include “opportunities” for reductions in staffing numbers of over 12,000 staff in Northern Ireland, the closure of hospitals, the closure of beds, and the freezing of pay. Voluntary and community groups providing non-core services “which currently substitute and/or prevent need for statutory care” could see their funding cut as part of measures headed “Savings achievable by reducing quality”.

The full report is available here. Appendices are also available:

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About Paul Bradshaw

Founder of Help Me Investigate. I'm a visiting professor at City University London's School of Journalism, and run an MA in Online Journalism at Birmingham City University. I publish the Online Journalism Blog, and am the co-author of the Online Journalism Handbook and Magazine Editing (3rd edition). I have a particular interest in Freedom of Information and data journalism.