THE head of the county’s hospitals has warned higher taxes or health insurance might be the only solutions to the NHS’s cash crisis.

Sir Jonathan Michael made the comments as he prepares to step down as chief executive of Oxford University Hospitals Trust (OUHT) next month.

The NHS nationally needs to make an estimated £22bn worth of cuts by 2020, while the OUHT needs to find a further £47m of savings in the next 12 months on top of the £220m it has already made.

In an exclusive interview, Sir Jonathan called for an urgent national discussion over the future of how the NHS is funded.

He said: “There is going to be a need for a conversation for the country, sooner rather than later, which says we have to find more money for the health service in one way or another.

“At the moment the expectation is the health service is going to make £22bn of further efficiencies by 2020.

“I have to say I am very sceptical about whether that is do-able.”

Sir Jonathan said that since 2010, when he took on his role, the health service had taken an effective pay cut because the cost of providing healthcare had risen faster than NHS funding.

While the NHS’s budget has been ring-fenced, Sir Jonathan said the ageing population and price of medication was putting huge pressure on its finances.

He added: “When you keep people alive, costs go up. We are seeing a significant downward pressure on activity and costs.

“There will come a point when the pips will squeak harder and harder and you will see significant financial pressure in providers – hospitals and trusts – more so than the commissioners.

“Either we will have to find more money as a country, through general taxation, or find another way.”

Sir Jonathan said the national discussion needed to focus on how the cash was raised, whether through higher taxes, compulsory health insurance or ‘co-payments’.

Co-payments are when the NHS contributes some of the cash, but patients have to pay the rest, such as with prescription charges.

There are currently no plans to introduce any of these measures in Oxfordshire or across the UK.

Healthwatch chief executive Rachel Coney stressed the current conversations being held in the county were focused on changing the structure of the healthcare system rather than levying higher costs. She added: “At the moment all the conversations we are privy to suggest that they are going to try to find ways to transform the model of care rather than raising the amount of money.

“We expect that to generate a series of really difficult and challenging conversations across the county.”

Sir Jonathan’s comments come less than a week after Oxfordshire Clinical Commissioning Group chief executive David Smith told councillors the health system in the county was structurally “flawed”.

Mr Smith said problems such as bed-blocking – where patients healthy enough to leave hospital cannot because there is nowhere for them to go – could only be solved with more money.

But Sir Jonathan said unless politicians and the public have a discussion over higher taxes, insurance or co-payments, it would be hard to make ends meet.

He added: “We could have health insurance schemes or co-payments. But there needs to be discussions.

“People talk as if co-payments are a complete anathema for the NHS. If we want to fund it by general taxation we need to pay more money, a lot more money. Until that happens it will continue to be very difficult.”

Ms Coney agreed the financial pressure on the NHS in Oxfordshire was going to create some very difficult choices.

She added: “We can absolutely echo his concerns about the financial challenges facing the NHS and social care are going to present.

“We expect the next six months to be dominated by conversations about how we are going to change the way we do things in Oxfordshire so they are affordable.”