Across the board, the NHS is regarded as an institution of which we are justly proud. Its fundamental principle on which it is built is that health care should be based on need and free at the point of delivery. The resulting cost  to the UK public purse is £75.8 billion, of which £11.6 billion spent in Scotland—that’s £2,210 for every man, woman & child living here, each year.

Compared to other countries—especially the USA—that remains something of a bargain. But ever-increasing demands that outstrip its resources mean that its budget is stretched, so much so that Theresa May has promised an extra’ £20 billion for NHS England. While much of the increase in demand can be explained by increasing demands from elderly living longer, ever-more sophisticated (and therefore expensive) equipment and medicines, a good portion is from the population having little idea of actual costs for the services they need. There is no penalty for missing appointments, mislaying medicines, losing equipment or even a

The price of a heart bypass operation ranges from £2,540 to £6,911. The cost of cataract surgery varies between £763 and £1,164.

Supermarkets are in the habit of telling us ‘how much you saved today’ on the bottom of till receipts, so what if we did something similar for healthcare? Doctors could start by printing the price of drugs to the NHS on FP10 prescriptions. This would be easy. The scheme could then extend to highlighting the cost of in-patient care on discharge summaries and out-patient visits on the bottom of appointment letters. Waste in the health service is huge and in part this is due to patients having no idea how much things cost. When prescribing an expensive drug,

When something is given numerical worth, even a nominal one, it suddenly makes it seem ‘of value’. Take the £1 deposit on supermarket trollies and 5p charge on plastic bags. These are simple ways that assigning a monetary value has changed behaviour radically; trolleys get returned and bags reused.

The standard prescription cost in England is currently £8.80 per item. That means that if you take in a prescription that lists several types of medication, you will pay £8.80 for each one. In Scotland, Wales and Northern Ireland all prescriptions are free for residents (or anybody who is registered with a GP in that country).

The 46,000 patients being treated for arthritis with the drug Adalimumab cost the NHS £400,000,000 each year. A fully kitted ambulance costs £250,000. To be reviewed on the telephone by a clinician costs £64.59, to receive an ambulance and be treated at home is £155.30, and to receive an ambulance and be taken to hospital costs £254.57. There are examples of abuse:

• A patient who called 999 more than 700 times in two years. The estimated costs to the ambulance service over a year was more than £110,000.
• A patient who cost the NHS £10,000 in callouts in a month.
• A patient who made 238 emergency calls over two months at a cost of £40,000.
• US visitors used to paying through the nose (just visiting a doctor costs £240) who receive treatment here are astonished that their grateful attempts to pay are refused because the NHS has no mechanism to receive even their card as payment.

This is not an argument to follow the example of the US where people lying on gurneys can be asked to fill out forms and prove that they have appropriate medical insurance before they can be treated. But there must be some happy medium. This needs to be found before the whole system becomes swamped by demand or cost so much that funds will be unavailable for other vital services like schools.

We are in a contradictory situation where, despite major diseases having been eradicated, nutrition improved so that few starve and modern medicine light years ahead of that available 75 years ago, everyone agrees that demands on the NHS will increase dramatically. This is for six major reasons:

1. An aging population with the elderly making the biggest demands
2. Burgeoning need for social care and its close relation to health
3. Growing awareness of and demand for mental health
4. Changing biosphere breeding super-bugs and weakened antibodies, due to living in more sterile home environments
5. People using the health service for their bodies the way they use garages for cars
6. Increased sense of entitlement, no matte how expensive the treatment or how self-imposed the malady, such as botched cosmetic surgery or uncontrolled drug habit

We may achieve a perfect world where all illnesses are treatable at a trifling cost. But we are nowhere near it yet. The treatment costs mentioned above and the demand for them will rise uncontrollably unless the beneficiaries (i,e, you and me) stat owning the problem. That means not only becoming aware of the costs but using the services judiciously as we really were paying for them. Either that, or we will wind up paying for them in our taxes—and still find waiting times stretching out into years.