Patient: I’m ill and need some treatment.

NHS: Yes, of course, let me look into that for you. Oh dear. Your course of treatment will cost £3,000. The NHS rations what treatments are available and unfortunately we’ve decided your treatment isn’t covered.

Patient: OK. Well, I’ve just totted up what I paid in tax last year – income tax, national insurance, VAT, tax on my house and car insurance, petrol duty, flight duty, electricity and gas tax, beer and wine tax – it came to £25,000. That’s the average household tax bill. So I’ve paid my share. Can I have the treatment I need now?

NHS: No.

Patient: But a third of government spending is on the NHS, so that means my household has paid over £8,000 into the NHS in one year, and you’re telling me I can’t have treatment that costs £3,000?

NHS: That’s about the size of it, yes. You should be grateful, you know. The NHS is the envy of the world. No other country on the planet has anything as good as our NHS.

Patient: Isn’t that “envy of the world” attitude a bit “Little Englander”?

NHS: No need for hate speech. Look, I’d like to help, but I’m only obeying orders. The system must come first. If we gave you the treatment we’d have to do it for everyone.

Patient: Well, what if I take that £8k, voluntarily donate £5k a year to the NHS and use the other £3k to pay for the treatment I need?

NHS: No, you can’t do that. That’s illegal.

Patient: Well, I’m not wealthy, just an average person, but what if I let you keep the entire £8k I give the NHS every year and then try to fundraise some money so I can go to another country for treatment? Some hell hole like Holland or Switzerland that somehow manage to provide better healthcare, where I can get the same or better treatment for just £2k. Would that be OK?

NHS: <Sucks air through teeth> We wouldn’t advise you do that. You wouldn’t like us when we’re angry. We wouldn’t like to have to send the police after you like we did with Ashya King.

Patient: You mean the little boy with a brain tumour who couldn’t get the treatment he needed on the NHS so his parents decided to take him to Spain? Didn’t he survive thanks to the treatment he got abroad?

NHS: We wouldn’t know about that. All we know is they defied the NHS so we had the police issue an arrest warrant for them, and they spent a few days in a Spanish jail. We can’t have parents thinking they know best for their children, now can we?

Patient: But surely the NHS only cares about what’s best for the patient?

NHS: Whatever gave you that impression?

Patient: OK. Well the NHS gets more money every single year. You’re getting an extra £80bn by 2020. Do you think you might be able to give me the treatment I need by then?

NHS: You can’t expect the NHS to spend all that extra money on patient care.

Patient: But I thought spending more money on the NHS meant spending more money on patients?

NHS: Whatever gave you that impression? Where do you think the extra NHS money goes every year? We have to have more and more managers and legions of non-clinical staff on ever higher salaries. That’s progress. You don’t get to be the fifth largest employer in the world by employing doctors and nurses, you know.

Patient: Well, I know the NHS has more than 600 managers who it pays more than £100,000 a year. That seems like an absolute fortune to me. Perhaps these non-clinical managers would be willing to take a 10% pay cut? That would raise at least £6million, enough to pay for my treatment and that of 2,000 other people in the same boat as me.

NHS: I’m afraid we won’t do that. We have to pay these managers lavish salaries or they will leave.

Patient: Where on earth are these people who have mismanaged their hospitals to the point of bankruptcy, who are given £150 billion a year to look after the sick and injured yet run out of money before they get all the nurses and beds they need, who have denied me the treatment I need despite me having paid for it many times over, going to get another job for over £100k a year?

NHS: Somewhere else in the NHS, obviously. Or perhaps on your local council.

Patient: I give up. Perhaps I should just die quietly, would that suit you?

NHS: If you would. That would be a great help.

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