The moral imperative | British Dental Journal

It never ceases to amuse me how defensive people can be about the National Health Service, regarding it as a deified religious cult about which not a single criticism must be made. Such

people believe in its promise and premise so fervently that they expect the rest of us to as well, rejecting any suggestion of its deficiencies as heresy or treason. The NHS truly is awesome

in the literal sense of that word. A behemoth of bureaucracy and one of the largest employers on the planet, that it can provide any service with any measure of efficacy is a minor miracle.

A grand undertaking, both ideologically and politically, to commit to safeguarding the health of an entire nation free of charge at the point of delivery is something other nations reserve

for the land of unicorns and elves. And there would be no service without the extraordinary people working in it. Politicians constantly shower them with hyperbolic praise in the cynical

hope of gaining easy political traction but it doesn't make that hyperbole an overstatement. The staff are some of the most diligent and dedicated people anywhere, overworked and

underpaid, fending off frustration and sometimes shocking abuse to save people's lives. And yet. Despite their valiant efforts, the system isn't great. The service is slow and

encumbered. People are waiting and waiting. And waiting. As a whole, and here is my treasonous heresy, it is simply not fit for purpose. The idea of a national health service is not

necessarily at fault. Nor are the nurses slaving their scrubs off. What the zealots need to understand about their precious NHS is that its existence is not and never was a moral imperative.

Like most things provided by the state, it came into being as a political calculation. Although conceived by a Conservative (Sir William Beveridge - not quite as far to the right as yours

truly), it was promised as a New Jerusalem by the incoming Labour government of Sir Clement Atlee in order to get elected. Good strategy too, as he managed to defeat Sir Winston Churchill, a

national hero after the Second World War. Promise to give people something, especially free at the point of delivery, and there's a pretty good chance they'll elect you to any

office. And at the following election promise you'll be the ones to protect that gift and not take it away, and they'll keep you in power. It's a time worn tactic that

throughout history has helped one civilisation conquer another. (If you rule by the gun people have nothing to lose and they'll eventually rise up and resist. Give them something to

lose and they can be controlled.) Didn't matter that Atlee couldn't pay for the new health service. He had to send the economist John Maynard Keynes to the United States to beg for

a loan. A loan they eventually and very reluctantly gave, and only half of what was asked for. A loan that took 60 years to pay off. Promise to give people something but then borrow the

money to pay for it. Always a winning formula… And, as you well know, at every election cycle every party of every political stripe will promise to invest in, protect and reform the NHS. If

there truly were a moral imperative to do so, it would have been done decades ago. But there isn't. Because the NHS is far too useful as a political football. The more conspiratorial

amongst you might argue that the same principle used by pharmaceutical companies in selling their products is used by our political system with respect to the NHS. _There is no profit in

fixing your problem_. So, in the same way that lip balms and face creams, for example, are designed to dry your lips and face so you will buy more of them, perhaps there is political profit

to be made from maintaining a paralytic health service. So that each party can promise to swoop in and fix it at the most opportune time. As cynical as that may sound, many reforms or

injections of cash are timed to coincide with events such as seasonal budgets or general elections. But we're dealing with people's lives here, so how do we make that a moral

imperative? By taking it out of the political sphere and creating a plan from a cross-party consensus? I know, I laughed too. And then I saw the unicorns and elves. It will never happen.

Those earnest and noble believers who vehemently defend the system's virtue need to throw some ice-cold water on their faces and wake up to reality. At the next general election, listen

to the promises and tell me I'm wrong. Political chicanery accepted, one of the biggest faults of the system itself is the focus on treatment. Most of the medical profession are

indoctrinated to treat disease after the fact, rather than to invest time educating people to prevent it in the first place. We all eat too much and move too little; we're overworked

and sleep deprived, trying to earn that extra bit of cash to buy things we don't need to impress people who don't care. Plus, the mortgage and school fees. And the tax to pay for a

health service to fix all the aforementioned problems. And treatment is expensive. Drugs are expensive. Especially when they don't solve your problem so much as prolong it. But

treatment can be measured, which means it can be funded. You can't appropriate money to something you can't see, like a conversation about the role of diet and exercise in

preventing a decline in one's health. Never mind that much of the time and funding of the NHS is absorbed by chronic conditions such as obesity, diabetes and cardiovascular disease, all

of which are preventable and even reversible with an appropriate change in lifestyle. But money is just something you throw at a problem so you can claim to have fixed it. We're all

paying for the NHS and all entitled to it. Even as a right-wing nut job I'd happily pay a little more tax if I believed it could help the NHS save a few more lives in a timely fashion.

That's my moral imperative. Rather than fawning over the NHS and festooning it with an unshakeable fidelity, it is worth sobering ourselves with the real obstacle inherent to its being,

that is its value as a periodic vote winner. Any reform or improvement of it will be a well-timed political calculation. You poor, faithful masses. They gave you this wonderful thing, which

you came to believe is sacred. And all they need to do to keep your faith is promise not to take it away. Always a winning formula. AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Dentist,

London, UK Sharif Islam Authors * Sharif Islam View author publications You can also search for this author inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence to Sharif Islam.

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