Treasury Minister Alfred Cannan refused to rule out the possibility of introducing some NHS charges after calls were made for services to remain free.

As Tynwald approved the independent review of Department of Health and Social Cares service delivery and funding, a number of members wanted some assurance that the basic principle of the NHS, that it was free at the point of delivery, would not be undermined.

Dr Alex Allinson (Ramsey) sounded a warning note.

He said: ’I think it is crucially important that Tynwald reaffirms our commitment to the National Health Service, whose founding principles are that healthcare should be free at the point of use, funded primarily through taxation, and provide a comprehensive service available to everyone according to their need.’

David Cretney MLC also sought assurances from Mr Cannan: ’Is he talking about privatising elements of the NHS on the Isle of Man? There have been errors made elsewhere and I would hate to see us going down the same road.

’If it is an open book and we are looking at the best way to deliver services on the Isle of Man, I am fully in support of that. But, if he is saying he thinks the private sector can perhaps do things better than we presently are, then I would be much more cautious.’

They were responding to Mr Cannan’s opening remarks, when he said options for the review to consider whether all health services should remain free at the point of delivery and other options could include a health tax or increases in National Insurance.

Lawrie Hooper (LibVannin, Ramsey) asked: ’Does that mean we are looking potentially at dismantling our NHS? That is not something that I will support. Free at the point of use is a fundamental tenet of the NHS. We cannot be determining what level of care people can receive based on their financial resources.’

Mr Cannan insisted ’difficult discussions’ needed to take place. But he insisted nothing had been decided.

Reacting to Dr Allinson’s comments about the principles of the NHS, Mr Cannan added: ’He is right, we do need to build on those principles, but we also need to examine how those principles apply in the modern world. It is time to look from a broader strategic perspective, to talk about how we are going to meet the funding requirements.’

Earlier, Mr Hooper, tabled an amendment that would have altered Mr Cannan’s motion to remove the change options for service delivery from the remit of the review.

Mr Hooper explained: ’This will focus the review on how we fund our services but allows the health department time and space to continue to implement its existing strategies and, even more importantly, to continue to develop them further.’ But the amendment failed 19-4 in the Keys and 9-0 in Legislative Council.

Health Minister David Ashford, who had been in office just eight days when the debate took place, backed the wording of the review.

He said: ’Rather than looking at what services do we need to provide, how do we provide the services and then how do we fund them, I always think we have done the reverse and come up with the funding first and then looked at what fits that funding model. That needs to end.’

Bill Shimmins (Middle) said: ’The assumption that the health service is free has been mentioned a few times already today, and that is absolutely understandable.

’It is a very dearly held mantra by many people. I think we need to test that. Is it realistic, given the ever-increasing costs for drugs and treatments? It is not the case in Ireland, France and Germany, where patients who are able to do so make a contribution to the cost of their care.’

A number of members warned against too much political interference.

Ralph Peake (Douglas North) said: ’Now is the time to support our qualified experts. Now is the time for political members to support the quality team. Give them the space to deliver a sustainable health and social care service.’