Ed Balls, the shadow chancellor, based his claim on figures covering 34 developed economies that show extensive health service charging in any country that shrinks its state spending to as small as 35% of GDP, the target proposed by the Tories for 2019-20. On average the level of charges is three times higher in those countries than in the UK at present.
“What [the chancellor] George Osborne is proposing represents a real risk to the future of the health service,” Balls told the Guardian.
Labour is trying to make the future of the NHS the focal point of the election campaign and will reveal new pledges next week on doctors, nurses’ training and social care.
There have been a succession of warnings from thinktanks that NHS finances are under unprecedented strain. Next week health workers are due to take strike action over pay.
The latest A&E waiting times published on Thursday showed an improvement on the previous period, but the government target of 95% of patients being seen within four hours is still being missed.
Labour says OECD figures show that four economies have public spending of 35% of GDP or less, all of which have greater “out-of-pocket expenditure” on health as a share of household spending than the UK.
It said the average level of out-of-pocket expenditure as a proportion of total spending on health was more than treble the UK figure.
The figures show that in 2012 UK government spending was 45% of GDP, and out-of-pocket expenditure represented 10% of total health spending.
Swiss public spending was 33% of GDP and out-of-pocket expenditure made up 28% of total health spending. Mexican public spending was 27% of GDP and out-of-pocket expenditure accounted for almost half of all health spending.
Balls said: “This is what the overseas experience shows if you go to these extreme levels of low public spending. There is a real risk that a second Tory government will introduce charges.”
The Conservatives will deny the claims and say this is another attempt by Labour to use the NHS for party gain. They said the figures may reflect different priorities of different countries rather than a causal link between health charging and levels of state spending.
It has already promised that state spending on the NHS will be protected in the next parliament, but Balls said the coalition had only partially set out the source of the funding for this pledge for the first year of the next parliament.
The Tories have previously pointed out that state spending briefly fell to 35% of GDP under Labour, but Balls’s office said this low point, inherited from the Conservatives, came just as Tony Blair agreed large-scale increases in NHS spending.
Balls denied he was scaremongering and cited a warning from the director of the IFS thinktank, Paul Johnson, who said Osborne’s plans required a fundamental re-imagining of the role of the state.
The shadow chancellor said: “In that light it is quite legitimate to ask questions about what the NHS will look like in this world. It is right to point out that all countries that have gone down to this level of public spending have much, much greater degrees of charging for healthcare than the UK does now. We currently have one of the lowest level of charges.
“In my view you cannot go down to such sustained low levels of public spending – the lowest for 70 years – and expect the NHS to remain recognisable. These are the largest cuts over four years since the second world war.”
He added: “Ten years ago in the 2005 Conservative manifesto written by David Cameron, the Tories set out plans for a patient passport that introduced charges for people that wanted to jump the queue, so Cameron and Osborne have got form on introducing charges for basic medical treatments.”
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