4,700 cataract operations, 1,200 hip operations or a lot less people with dandruff?
This is not the opening gambit to an elaborate joke. NHS England recently revealed the health service currently spends £4.5 million annually on anti-dandruff shampoos.
Now whether or not you think this is good value for money, whether or not you believe that a shiny-haired workforce is more important than a few thousand people with blurred vision or several hundred with hip pain, what you cannot do is ignore the rationing debate.
In the year to June 2017 the health service spent £569 million on prescriptions for medicines that can be purchased over the counter: vitamins, head lice treatment, indigestion remedies, athlete’s foot cream etc.
The NHS was established at a time when a significant percentage of the population was dirt poor
Of course it is not a simple as saying stopping over-the-counter prescribing would free up £500 odd million a year for use elsewhere in the NHS. For a start, it would need to be ringfenced to stop the money just being swallowed up paying off trusts’ deficits.
And then there are those who simply cannot afford the cost of, say headlice treatment. Would we just have to accept some schools will be overrun with the critters so some people can see more clearly?
The NHS was established at a time when a significant percentage of the population was dirt poor and literally could not afford any medicines no matter how cheap they were. Times have thankfully moved on, and on the whole people are healthier and wealthier than ever before and certainly better off than when the concept of free universal health care for all was first conceived.
Any debate on rationing is usually dominated by a loud chorus of complaint from the ‘I paid my taxes’ brigade. Well yes, you probably did, but for many of you it was a long time ago and when you paid tax nobody could have imagined the enormity of the range and cost of the treatments the NHS would be providing now. So, to be blunt, you need to get beyond the idea that what you paid in tax can cover all the health needs for a population who are increasingly living into their 90s and 100s.
What is needed is an open and honest discussion about rationing and it needs to be led by clinicians not politicians, whose main concern is winning the next election.
There are two main choices: pay a lot more tax and fund the health service properly, or accept that we are no longer able to pay for every health-related cost for everyone from cradle to grave.
Dr David Turner is a GP in West London
