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25 February 2020
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Sustaining the right to privilege – for all

Helping my daughter procure her insurance as an essential component of her holiday budget might seem a strange reminder of just how wonderful the NHS is. As we navigated the endless cop-outs (eg if the snow is slippery, you are not covered if you go outside) we got to the nitty gritty of health cover and the usual description of an alien system.

To paraphrase: should you require medical assistance on the slopes, you will need to pay ‘in advance’. You will be liable for an excess and will be reimbursed on submission of appropriate receipts. Your EHIC card will not cover this. Presumably to take your mind off your injury, if you cannot afford the bill up front, you must ring…Oh, and by the way, if you need any drugs, they must be paid for separately, etc.

You know the score in the UK: dialling 999 will summon an ambulance, or the Coastguard/RNLI, or, if you are in an inaccessible place, a mountain rescue team and/or a helicopter. Seamlessly and without question you are whisked to safe, high quality medical care and treated irrespective of the expense (or, at this stage, your nationality) until such a time you are sufficiently recovered and able to go home.

This is our right. And, however much we rail against it at times, a system which removes the burden of affordability from the sick and injured must be considered wonderful. But how many of us ‘on the other side’ of the equation reflect on the privilege of being able to offer the best in healthcare without concern for the cost, where the fifth intercostal space marks an important anatomical landmark, not the site of the wallet! How would we feel if the stresses of consultation and treatment were added to by negotiations on affordability? Where perhaps suboptimal treatment was the choice of the patient, based on affordability?

A privilege

I do not fear for the continuation of the NHS in the short-term, despite the intermittent political prophesying, but I simply do not know how much future generations will be prepared to fight for what (I am assuming) so many of us see as a privilege and currently hold dear.

Many nations do not have anything akin to our wonderful NHS and there are various examples of systems based on the ability to pay with, no doubt, logical and utilitarian arguments. Could our outlier status sway decision-makers - divorced from the realities of the front-line - away from ‘free at the point of delivery’? Would they gain support from generations separated by too many decades from the pre-Bevan days?

As we anticipate what some are calling the most crucial budget of recent times – on 11 March – we must remind ourselves of what we could so easily lose, if we are not watchful, diligent and prudent.

Sleepwalking into disaster is not an unknown phenomenon. I have watched the steady erosion of many so-called privileges, only to see the impact of their loss recognised too late. Reintroduction is often harder than sustaining the levels of resource required to maintain what is good.

Complacency is dangerous, but we cannot simply demand that future generations look after the NHS. Yet we can discuss it. We can discuss the implications of issues like care dependent on the ability to pay. We can debate the difficult dilemma of the patients who must choose poorer or restricted care based on affordability, prevalent in so many other countries.

Leaving the last words to Horace (again): While we're talking, envious time is fleeing: seize the day, put no trust in the future or holiday insurance.

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