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‘We should think of the NHS as precious but not unlimited’

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I am sitting outside a cafe in Brighton with a friend talking about life and watching the clouds.

A loud posh woman is shouting at her children to stay within her sight while they play. She has a loud voice and the children are called Moffle and Bottlehead or something.

“I imagined Moffle growing up to be health secretary because he won’t like people either”

They weren’t listening, they were running around screaming loudly, scaring homeless people and generally exhibiting the inarticulate rage one must surely expect from a child who had been named Moffle.

The woman sat down near us and started talking about Moffle having to go to hospital recently – presumably to have his name amputated – and how horrid she had found the experience.

There was nowhere to park, the clinic was running late, the hospital smelt and the doctor didn’t really seem to take Moffle’s ailment – a rash on his back which turned out to match the inlet cover on the family Jacuzzi – as seriously as they might.

“What annoys me” she said, watching Bottleneck throw a brick at a pigeon, “is that we pay our taxes but when we try to use the service our needs are not met”.

Then she looked around the square at all the other people who had needs and were using the service she funded and I don’t think she liked them. I imagined Moffle growing up to be health secretary because he won’t like people either.

I wonder if problems in managing the NHS are compounded by my own changing perception of what the NHS is and who it is for. As our sense of its value has become so inextricably tied up with what it costs – or more precisely the unevidenced assumption that it costs too much – then we have begun to think primarily in terms of value for money.

Of course, from there it is not that difficult to move from “are we collectively getting value for money” to “am I getting value for money?”

Moffle’s mum appeared lucky. Yes she was stupid, but even then, she didn’t seem to know it and so it only really bothered other people. Beyond that she was healthy, her children were healthy, she didn’t need the healthcare she paid taxes for and perhaps that annoys her. Particularly if she decides to invest in a story where other people who are less deserving, or who pay less tax, or who simply aren’t like her, do get to use the health service. Obese people with heart problems, skiers with broken limbs, children with rashes that don’t match the Jacuzzi.

“The NHS works best and is most sustainable if we think of it as precious but not unlimited”

Yes, we can tell Moffle’s mum that she will need healthcare. Maybe next year or the decade after, or when she is 85, she will need it. But that isn’t going to make much difference because there is a mentality that wants a return on investment now – not everywhere but in some places. In a strange way I think it contributes to the debate around funding and maintaining the NHS that seems to me to be unhelpful.

The NHS works best and is most sustainable if we think of it as precious but not unlimited. Our relationship with it is a collective one, it ensures ill people are looked after. Our turn will come. It always does but while we wait, we need to be protecting and limiting what it is used for.

I realise that in this context, I am perhaps stating the obvious, however, I can’t help but feel that establishing limits around what we can expect in terms of treatments and responsibilities is not a debate we have ever openly had, is it? And hard as it is given the calibre of politician we are burdened with these days, I really feel we should.

Mark Radcliffe is senior lecturer, and author of Stranger than Kindness.

Follow him on Twitter: @markacradcliffe.

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