All healthcare systems ration. Single-payer models dependent on tax revenue, like the NHS, tend to ration with access to treatment and waiting times.
The utilitarian defence of such systems is that they are universal. If I’m waiting for my hip replacement, so are you. If you can’t access an experimental drug for your ailment, my friends and family can’t either. There are no tiers. It’s “fair”, they say. It’s equal.
Of course, in practice, it’s not. Your postcode will determine whether you get rushed to an outstanding hospital or a failing one. Conveniently, the one across the road from parliament often ranks in the top 10 hospitals; the same cannot be said of the local hospital for people in Worcestershire.
Now, it turns out, your marital status matters as well.
News sources earlier this week reported that NHS South East London is denying single women access to IVF treatment because, according to the report, single mothers “exert less control on their children” and “place a greater burden on society in general”.
There are plenty of cultural and even philosophical questions to unpack here, about parenthood, upbringings, and the rest. As someone who was raised in a single-parent household for most of my childhood, I understand the hardships that come with the lack of a dual-support system. That said, an active and loving parent’s presence trumps a dozen passive guardians.
None of this, however, is the point. While we can debate over family units until the cows come home, it is no business of the NHS to make such judgements. It is meant to provide access to care, not pontificate about who deserves it.
You can make the case for clinical criteria that might prevent someone accessing treatment (indeed, there is an age cut-off to receive IVF on the public purse). And perhaps it isn’t the job of the NHS to provide IVF at all, as some argue the focus should be on basic and emergency services, rather than trying to be an “all inclusive” package.
But as long as the NHS does provide women with IVF treatment, it should not be determining which women are worthy of public access, based on how heavily their ring finger is weighted down.
Thankfully, many have flagged this policy as discriminatory, and a “rapid review” has been announced. But fertility is not the only area where NHS attitudes should concern us.
The narrative around lifestyle habits, and their implication for the health service, has been on the rise for years. Drinkers, smokers, and people who are overweight have been blamed and shamed for soaking up NHS resources.
Never mind that the former two groups more than cover the costs they impose on public finances, providing a net saving to the Treasury of £22.8bn. The narrative is removed from fact, creeping closer to crude intervention every day.
The NHS is used as trump card to force people into lifestyles the state would choose for them – whether that be one of sobriety or death-do-us-part – rather than the one they might choose for themselves.
If you care about universal access, not just to healthcare but good healthcare, it’s time we assessed the NHS more honestly on that criteria, and were not frightened to flag up where it fails.
Main image credit: Getty