Looming local elections have spurred Labour Party leaflet writers to dredge up comments made 13 years ago by Nigel Farage saying the NHS could be scrapped in favour of a health insurance-style system. Scary-looking fake medical bill letters stamped with "payment overdue" have been sent out to households, with a claim voters will owe £75,000 in medical bills if Reform UK win power.

The Telegraph reports the final demand-like leaflets, which are also emblazoned with the words "your NHS bill under Reform" have been cobbled together using calculations based on how much procedures cost on the US healthcare system. On the letters, which look like invoices, a list of services with a price is shown, examples include a GP appointment costing £129, an A&E visit for £1,368, and coronary bypass surgery apparently setting someone back £71,997.

The Labour election attack is based on comments made by Nigel Farage in September 2012, or six Prime Ministers ago, when he was leader of the UK Independence Party (Ukip). Mr Farage said at the time he could be in favour of a "insurance-based system of health care" rather than "us trustingly giving £100 billion a year to central government expecting them to organise the health care service from cradle to grave for us".

Reform have accused Labour of using underhand tactics by using old quotes from more than a decade ago from their leader. A source told the Telegraph: “The Labour lie machine is in full-on panic mode.”

Mr Farage too has previously issued his own rebuke on his 2012 comments. In 2015 he said his views on privatisation of the NHS had changed, and on the campaign trail in Country Durham on Tuesday, he said: “We’ve never, ever, ever, suggested anything other than the NHS should be free.”

However, a Labour source defended the leaflets, telling the Telegraph: “The public cares deeply about the NHS, and the principle of it being free at the point of use is non-negotiable for almost everyone. It represents British values."

Voters in 23 local authorities in England will go to polling stations between 7am and 10pm on May 1 to choose their new councillors in the first big test at the ballot box for political parties since Labour won the general election in July 2024.

A total of 1,641 council seats across the 23 authorities are up for grabs, and Reform is standing 1,631 candidates, more than either Labour or the Conservatives.

The Conservatives have 1,596 candidates (97.3% of seats) while Labour has 1,543 (94.0%), while further behind are the Liberal Democrats, with 1,396 candidates (85.1%), and the Greens, with 1,183 (72.1%).

There are also contests for six mayors in England, and the first by-election of this Parliament, for Runcorn and Helsby, after the resignation of the previous MP Mike Amesbury.