By the way... Sadly, NHS rationing was inevitable

WHEN I became a junior doctor, the NHS was just 25 years old and we were all coming to terms with what it meant to provide free healthcare at the point of delivery.

I was becoming concerned about the growing waiting lists — a political hot potato at the time. But my father, an established anaesthetist who had worked as a battle surgeon before the creation of the NHS in 1948, warned me there would be further challenges ahead.

As he observed back then, there is only a certain amount of cake to go round, free service for all or not, so some form of rationing would be necessary.

In those days, demand for healthcare was managed by way of waiting lists. But my father warned me that, at some point, it would become politically unacceptable to have to wait for care and, once that day came, there would have to be more subtle ways of depriving the public of the care it had been promised.

One way is to make it harder for people to qualify for treatment.

And now we learn, not least from the Mail’s investigations, of the widespread restrictions on cataract operations — with three-quarters of NHS hospitals denying the surgery to all but the most visually impaired patients.

In a similar policy, joint replacement for knee arthritis is to be restricted in certain areas by tough selection criteria set by the local commissioners, while previously it was the decision of a specialist orthopaedic surgeon following referral by the patient’s GP.

The days when healthcare was governed by doctors functioning within a code of ethics are clearly over — the ministrations and cost-cutting antics of administrators and commissioning bodies are not informed by ethics.

Of course, care must be taken when spending public money on potentially expensive treatments, but the proper application of medical ethics must apply — we should strive to make decisions on the basis of individual medical need rather than blindly adhering to blanket rulings imposed from above.

And maybe now is the time to come clean, Mr Jeremy Hunt, and admit the mantra of free healthcare for all at the point of delivery is no longer something the nation can afford.

It is time to admit to rationing and accept that some will suffer — and not let it creep in by the back door.