Ideas such as Sajid Javid’s suggestion that patients should be charged for visiting GPs or hospital emergency departments show the Conservatives are “testing the water for a different kind of NHS”, Gordon Brown has said. Writing in the Guardian, the former Labour prime minister says payment for services will end up with people missing early diagnoses and undermine the entire basis of the NHS. Javid, the Conservative former health secretary, told the Times on Friday that the NHS could not “survive much longer” without radical change, including regarding some fee payments. Javid, who will stand down as a Tory MP at the next election, cited as possible examples the fee of about £20 required of patients to see a GP in Norway or Sweden, and Ireland’s charge of €75 for people who arrive at a hospital A&E without a referral. Javid’s intervention was, Brown wrote, “no accident”, noting that Rishi Sunak used the services of private healthcare and, when, campaigning to become prime minister, had proposed a charge for people who missed GP appointments. “And so once again, as they did in opposition at the turn of this century, with alternative prescriptions [a 2002 Tory document on ways to finance the NHS], Conservatives are testing the water for a different kind of NHS. Today’s Conservatives may have clapped [for] NHS nurses and health workers at the height of the pandemic; yet they are not only opposing decent remuneration for them but also contemplating a more privately financed healthcare system,” Brown wrote. A move to payments would create “a two-tier healthcare system” in which better-off people took out private cover, Brown argued. It would be “not only morally concerning, it would also be most costly and economically wasteful”. He wrote: “As the overseas experience of billing and means-testing shows, charges not only mean higher administration and collection costs, they also discourage the sick from seeking treatment until too late – when more severe problems require not only more intensive, but more costly, interventions.” An ageing population and growing numbers of people with chronic or long-term diseases did mean that change was required, Brown said, but he said this should be focused instead on resolving issues around social care and the drain this placed on NHS hospital beds, plus on tackling underlying factors. Conservatives “seem to find more joy in one person joining Bupa than 60 million people using the NHS”, Brown said, adding: “But what we know of the rising pressures from health inequalities, from the path-breaking work of Michael Marmot, should turn the focus of our attention from this ideological sideshow of charging and private insurance to tackling entrenched poverty and the other social determinants of ill health. It is by attacking and eradicating the causes of ill health that we will do most to reduce waiting lists and pressures on the hospital sector.”