Whitehall sources said there is government interest in such ideas, as part of efforts to maximize efficiency in the service.
Steve Barclay, who was health secretary for two months this summer before returning to the same post this week, has taken a keen interest in spending management.
In his most recent speech, he highlighted the fact that there are now over 50,000 people working for the NHS who do not provide direct patient carecalling for action to ensure that the health service is an effective manager of public money.
An audit ordered by Barclay found a doubling in the number of NHS middle managers since NHS England was created in 2013.
Registration of delays in the waiting list
The Balancing the Books report says the Department of Health must be protected from future cuts.
But he says major changes are required to cover existing budget shortfalls, at the same time dealing with record backlogs on the waiting list, with 7 million now on the list.
The report warns: “Spending at the DHSC (Department of Health and Human Services) now substantially dwarfs any other department and has quadrupled in real terms since the early 1980s.”
Between them, the DHSC and the NHS in England cost £2.8bn, most of which is spent on staff.
The NHS body is currently merging with other organisations, following earlier instructions to cut red tape.
But even after this process is complete, the NHS body and its regional arms will have 14,000 staff, the Policy Exchange report says.
As well as calling for NHS England to return to the Department, while maintaining a separate board and management, the Policy Exchange report says a large number of watchdogs should be merged to reduce backroom costs and duplication.
Call to have free prescriptions removed
And the think tank is calling for most free prescriptions to be removed, warning that nine out of 10 prescriptions are dispensed for free. Instead, exemptions should only be given to those with the lowest incomes, he says.
The scheme is currently among the most generous in Europe, with nine out of 10 prescriptions dispensed in the community for free, the report notes.
Everyone over the age of 60 gets free prescriptions, along with most people who receive benefits, pregnant women, new mothers and people with a number of common ailments.
Last month, Barclay ordered a freeze on recruitment across the DHSC, saying over-management had become a burden on the NHS frontline.
He said it was a “natural place to start” in realizing efficiencies, as it will soon account for 40 percent of daily government spending.
In the same speech, delivered at Policy Exchange headquarters, he called for “fewer core priorities, with a focus on those that have the most impact” across the health service.
The think tank is calling for changes that would mean most people would pay the charges, which now stand at £9.35, with exemptions only for those with the lowest incomes.
‘Duplicate’ ineffective treatments
It also says that up to £2bn a year could be saved by “eliminating” NHS treatments that have proven to be of little use.
It calls for “doubled efforts” to identify ineffective treatments, and previous efforts have recommended stopping procedures such as surgery for snoring.
and suggests that consulting spending across government should be cut in halfwith £2.5bn spent in 2021.
“As the UK left the EU and the UK has successfully implemented a Covid vaccine programme, the two main drivers of the use of consultants and professional services have decreased,” the report states.
Robert Ede, director of health and social care at Policy Exchange, said: “Along with the prescription charges, Policy Exchange suggests that the Sunak government undertake a review with the intention of consolidating the 18 different practitioners and regulators in the system into health and care. This, combined with a reduced NHS England, could lead to savings of up to £1bn a year.
“This is not a quango bonfire – we are proposing tough decisions to ensure the resource can be re-prioritized towards areas like mental health, cancer and emergency care.”
An NHS spokesman said: “The NHS is already one of the most efficient health services in the world: only 2 pence of every NHS pound is spent on administration, compared to twice as much in France and four times in the US.
“NHS England already has plans to reduce the number of posts across the organization by up to 40 per cent, and across the NHS the number of statutory boards has fallen by three-quarters compared to a decade ago, from more than 200 to only 42.”
A government spokesman said: “In the last two years, an additional £36bn has been added to NHS budgets specifically to fund temporary impacts of Covid on the NHS, such as PPE, testing and infection control measures.
“We recognize that public services are under pressure due to the global economic situation caused by the pandemic. The NHS resource budget in England is currently £152bn and will rise to more than £162bn in 2024-25, the largest spending on health and care in the history of any government.
“We are focusing on new ways of working to increase efficiency, save staff time and ensure value for money.”