Column

The prince and the pauper

On the day Prince Charles’ shattered Polo arm was re-set in an NHS hospital, Peter Smith broke a leg playing kickabout with the kids.

As everybody knows, Prince Charles lives in a palace, has a first class education under his belt, travels the world with his work, and generally has a thriving life. Peter Smith is not so lucky. His home is a council flat in the city - not built ten years but run down already. Peter’s furniture is as threadbare as his life. He has no job and no savings - the only thing the pauper and the prince have in common is a disillusioned wife.

By the end of the day both Charles and Peter were in plaster, in the same building. They had been treated for a similar problem, with respect, and without charge. As nearly as possible they were treated equally. But should they have been?

The founders of the NHS dreamt of a comprehensive service, available to all citizens equally, on the basis of medical need. Prince or pauper, the NHS would not discriminate because wealth and status were thought to offer no protection against sickness and injury. It seemed simple at the time: everyone is intrinsically equal therefore everyone has an equal right to care and treatment.

But the founders of the health service had in mind a very different world to that of Britain in 1993. The NHS was established shortly after the war, one of a range of social reforms intended to further progress towards an egalitarian society. The NHS was meant to reveal the unmet needs of the poor, the meet them, and so to play its part in equalising the classes.

But egalitarian Britain never happened, and demand for health services is now so great that rationing is common-place. We are left with an NHS still attempting to apply the principles of equality within a country which has forgotten why they matter.

The British live unequal lives - some have huge houses while others sleep on the streets, some have two cars while others beg for a bus fare. Yet all are equally entitled to NHS support when they fall ill. But if equality isn’t important in Britain at large, does it make sense to pursue it - as ‘equal access for all’ - within a cash-limited health service?

The answer, of course, has to be no. Where there is rationing in health people cannot be treated equally. And where there has to be rationing, then equal treatment of unequals is not an egalitarian policy. Egalitarianism requires unequal treatment of unequals in order to bring them closer together.

When Prince Charles took advantage of the NHS many thought his choice simply unfair. And if Charles’ attitude is of moral concern, can’t the same be said for the Lord, the stockbroker and the executive?

True to the spirit of its past, the NHS might again champion egalitarianism, take a principled lead, and begin to charge princes for its services so as to ensure justice for the paupers.