Dominic Raab and other Tory ministers said Tory governments should look at charging individuals directly for NHS services, and called patients "customers" in a book they wrote in 2011, VICE can reveal.
On Tuesday, Foreign Secretary Raab faced questioning on BBC Radio 4's Today programme about the pro-privatisation views in a 2011 book called After the Coalition. Nick Robinson pressed Raab about his views on the NHS. As a vein on the side of his head throbbed, Raab claimed, "I've never advocated privatisation," and said Robinson was relying on "a snippet from a pamphlet I've issued a long time ago".
The "pamphlet" – in fact a 247-page book – does indeed talk about copying health systems where up to two-thirds of hospitals are "run privately", and argues that "private operators should be allowed into the service, and, indeed, should compete on price".
The book was written by Dominic Raab, Priti Patel, Liz Truss and other Conservative MPs who were then on the fringe of the party, but who went on to win top jobs as ministers.
Raab seemed embarrassed on the radio, but VICE can reveal that there is more – and worse – in his 2011 book, including an apparent suggestion to look at charging patients for NHS services.
In a chapter in Raab's book headed "Facing the Demographic Challenge: Funding the NHS for the Future", it is argued that "an ageing population will require even greater healthcare provision" – and that, even with better healthcare methods, it is "unlikely" the country will have "enough to ensure adequate investment in the NHS for the longer term".
Raab and his co-authors argue that, thanks to rising obesity and an increase in the number of older and sicker people, "the scale of the fiscal challenge is immense". With costs rising, they say, "it is worth asking whether it is time for the relationship between individuals and their own contribution to their healthcare to be considered".
Raab and co are not very direct about what this means, but they are strongly implying an "individual contribution" – presumably some kind of extra charge to patients or means-tested fees, rather than relying on taxes.
They argue: "In the UK we are unique in our dependence on the State – i.e. the taxpayer – to foot the bill for the healthcare of even our wealthiest citizens. While many social insurance systems in Europe feature public finance of slightly more than 75per cent. In the UK our healthcare system relies upon the taxpayer for 82 percent of its total healthcare bill."
In the UK, around 82 percent of NHS money comes from taxes. Another 17 percent comes from National Insurance. Just over 1 percent comes from charges to patients, like prescription charges. So Raab and co seem to be suggesting another 7 percent of the NHS bill should come from some kind of patient charge or patient insurance.
Presumably, because this was politically explosive, they are vague about what kind of charge, apart from arguing it should not be taxes. They ask whether rising health costs can be met "merely through increased taxation, or is there another way?" This "other way" is never fully explained, but the implication is some kind of means-tested charge.
Raab co-wrote After the Coalition, with Priti Patel, Liz Truss, Kwasi Kwarteng and Chris Skidmore – all MPs isolated on the right of the party at that time. Cameron was prime minister of the coalition government, and Raab and co were arguing the Tories should prepare to move sharply rightwards once they could get rid of the Lib Dems. Since Boris Johnson became PM, all of the authors have become ministers.
The book contains other controversial views on the NHS. As well as promoting privatisation, it says that "there is a suspicion that sometimes the system meets the needs of its staff more than its customers", and implies British GPs are overpaid because they get nearly twice as much as French or German doctors.
After the Coalition also contains a chapter called "Prison Works", which reportedly was written by Priti Patel – then a backbencher, now Home Secretary.
Patel used the "tough" language that Boris Johnson now shares, arguing against the "surge of soft justice, placing more value on the rights of offenders than those of victims".
Patel's chapter says, "We are not ashamed to say that prisons should be tough, unpleasant and uncomfortable places," and that private prison corporations should supply the new unpleasant prison places because "all the evidence suggests that prisons in the private sector are 15 percent cheaper and also achieve more in getting prisoners working".
Given Patel’s role as Home Secretary, the approach to immigration in the 2011 book is also relevant. The book complains about the "pattern of employment away from UK nationals towards migrants gaining full-time employment in the UK". However, the authors do not propose fast reductions in immigration, as there must "be a long process" of education to make UK nationals the "brightest and best" needed for jobs. Instead, Patel and co suggest continuing immigration, but with a big reduction in migrant workers' rights.
The book proposed "for each migrant worker, upon entry to the UK, to be given an Enterprise Card. There would be automatic recognition that no worker would be entitled to state benefits, schooling, or NHS services. Only after ten years would an Enterprise card holder be eligible for UK citizenship, having demonstrated employment and a record of paying tax over ten years."
Patel and co claim this "Enterprise Card" is modelled on the US green card, but it is much stricter. They proposed a system of guest workers who are excluded from the NHS and even schools. By contrast, US green card holders are typically allowed benefits like Medicaid, food stamps and education. Furthermore, green card holders normally only have to live in the US for five years – half the time Patel and co proposed – and be of "good moral character" before they can become citizens.
VICE emailed Raab and Patel’s offices for comment, but they did not respond.