Nigel Farage breaks with his Welsh leader over insurance system for the NHS

Reform UK’s Welsh leader has ruled out moving to an insurance-based healthcare system, despite the party’s U.K.-wide boss Nigel Farage keeping the idea on the table.

Dan Thomas, who took charge of Farage’s populist right-wing party in Wales last month, said he would not consider “any kind of insurance-based” reform to Britain’s National Health Service (NHS).

Thomas spoke to POLITICO for a special feature and Westminster Insider podcast on the battle for the Welsh parliament, the Senedd, on May 7. Both will be released on Friday.

His position differs from that of Farage, who leads the insurgent party across the U.K. It is an early sign of the challenge that faces Farage — who has long had a presidential-like hold on his parties — in reconciling the messaging from Reform’s growing network of office-holders.

While a Reform spokesperson told POLITICO it would keep the NHS free at the point of use for British citizens, Farage has not ruled out other reforms, such as moving funding of the NHS from general taxation to an insurance system.

Asked at the party’s Welsh manifesto launch on Mar. 5 if he would be prepared to look at reforms such as a French-style insurance system (in which citizens have mandatory insurance and pay through social security contributions), Farage said: “That would be a national decision ahead of a general election.” 

He added: “On the big U.K. picture of health, I’m prepared to consider any alternative to the failure we’ve got now … as for devolved powers, I’ll let Dan speak to that.”

Thomas later said he would not support moving to an insurance-based system in Wales. “No, no,” he said in an interview. “We rule out any kind of insurance system or any kind of privatization. 

“It will be free at the point of use. That’s what the public in Wales wants, and that’s what we will deliver.” 

Asked if he disagreed with Farage’s remarks on an insurance model, Thomas replied: “Look, Nigel’s also said that devolved issues are down to the Welsh party, and I wouldn’t consider any kind of insurance-based or private-based system for the Welsh NHS. 

“I think we can improve the NHS in Wales within the existing £14 billion budget, and it just takes focus. We [also] need more ministerial authority and intervention when services aren’t delivering.”

A Welsh test

Polls predict Reform (as well as Welsh nationalist party Plaid Cymru) will surge ahead of the Labour incumbents in elections to the Senedd on May 7.

“We rule out any kind of insurance system or any kind of privatization,” said Dan Thomas. | Jon Rowly/Getty Images

The future of the NHS is a key attack line in the campaign for the center-left Labour and left-wing Plaid Cymru, who accuse Reform of flirting with privatization.

Reform said in its 2024 general election manifesto that NHS services “will always be free at the point of use,” though not for foreign citizens. In November, the party announced plans to raise the existing “health surcharge” for visa applicants from £1,035 to £2,718 per year.

A Reform UK spokesperson said Wednesday: “We will always keep the NHS free at the point of use for British citizens.”

The comments from Thomas and Farage appear to raise the prospect that Reform UK could consider one funding model for England and another for Wales.

Mark Dayan, a policy analyst at the Nuffield Trust, a nonpartisan health think tank, said this would technically be possible, but changing the model at any level would be a major upheaval.

“It would certainly be possible for Wales and England to have different approaches to coverage and user charges, because health is already a devolved issue,” Dayan said. “Wales already has some separate user charging policies around prescriptions, for example.

“The taxation side of it will be really complicated … you’d be taking a lot of money out of some taxes and piling it into payroll taxes to make it social insurance. So you’d have to rewire things quite a bit, and some of that would probably require you to redesign how money goes from Westminster to the other U.K. countries, whether or not they had social insurance as well.”