Talk to a child about the founding principles of the NHS, and they will invariably say they sound just right. Like many people of all ages, they believe health is a basic human right and, unlike housing or food, should not correlate with the size of your pay packet.
But as these kids get older they realise human nature is such that we are liable to abuse what is provided for free. We tend to gorge on free-for-all buffets; I remember the lengths we went to as students to lay the ‘foundations’ of our salad bowl at pizza establishments. They were always left uneaten.
As a teenager, I remember suffering with viruses, period pain, abdominal pain (which I now know to be IBS) and headaches (which I now know to be migraines). I didn’t dream of attending the GP with any of these ailments as I felt they were a normal part of life.
In today’s society, nothing is normal as you can’t be too careful, can you? A cough lasting two days is a chest infection until inspected by my magical tubes. A headache for three days is a brain tumour until proven otherwise by my ophthalmoscope. A relationship breakdown four days ago is depression, until my mental state examination.
And don’t misunderstand my point. I am an avid NHS supporter. It is a safety net for the poor, children and elderly and is hugely underfunded: only 9.4% of GDP compared with 17.7% in the US and more than 11% in France and Germany.
But how can we offer fair services for everyone without discrimination, while also ensuring people use the system responsibly?
First, we must address DNA issues, which cost the NHS £700m a year. When I book an appointment at the dentist or hairdresser, my credit card details are logged and I understand I will be charged if I fail to show up. Yet there are no consequences for depriving another patient of an appointment in the NHS.
Drug wastage costs the NHS approximately £300m annually, but we continue to dish out multiple medications to patients who don’t pay a penny for them. A nominal charge for all patients, regardless of income, would deter patients from stockpiling drugs and asking for cheap, over-the-counter medications. Patients who want esomeprazole or Gaviscon rather than the alternatives, should have to pay for the privilege.
Those who wish to pay extra for these choices should be allowed to. I will happily see the commuter in my Saturday morning clinic for a fee of £75, provided an NHS prescription can be generated if required. Even commercial organisations in the US do not offer routine care on Sundays, as few people would be willing to pay the hike in insurance rates to cover this. Yet the Tories believe the NHS should offer just such a service.
Evidence suggests I am in the majority when I say I want the philosophy of this amazing institution to be preserved. But we have to think like adults, because if we continue to abuse the NHS, we will lose it.
Dr Shaba Nabi is a GP trainer in Bristol.