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18 March 2013

One concept that Margaret Thatcher got across is that you cannot abdicate responsibility for yourself, even when you have someone else looking after you. This is somewhat different from her being cast as professing a creed of outright individualism.

The hot potato of healthcare shows up the distinction quite well.

On the Continent everyone knows they are responsible for their own health and knows it even when they go for help. People are much more likely to be intensely interested in it and swap information about who is a good doctor, which one drinks too much, which is a good dentist, which one is in too much of a hurry, which is a good clinic and so on. This irrespective of means or educational attainment. Practitioners rarely question patients' decisions although they have some legal duties.

The NHS (and it has to be said most private practitioners educated in the NHS system, too) has for long - over 60 years - sought to make patients abdicate responsibility to it despite absorbing some incredible percentage of all taxation, about 20%. It would still, on the face of it, prefer zombies for patients, to make all the decisions and give near to the minimum of information. The patients being responsible for their own health is reinterpreted as insisting on overwhelming compliance with some bonus-driven, unwise regime of taking statins or, possibly, blood pressure medication (if one in two people over 60 'have high blood pressure' it strongly suggests the limit is set too low). Infantilising rather than respecting informed autonomy.

Its genesis, when it started off as an army-like institution where you did what you were ordered, then its development into an internal market type organisation where funds still do not follow the individual patient, have held it in very bad stead.

Imagine how much you would call the shots and how much the service would improve if you commanded the 20% of taxation yourself. Politicians and civil servants have been too much concerned about the producers and not the patients.

The result is catastrophic failure of professional ethics as at Mid-Staffordshire NHS Trust (which would not have been tolerated by Margaret Thatcher) and the existence of the most authoritarian social institution in Europe.

The issue is now at a head because the chairman of the NHS Commissioning Board has been reported as indicating that charges may have to be made by the NHS "unless the economy has picked up sufficiently" though both he himself and the Secretary of State are not in favour of charges.

One fears for those unable to pay because the NHS absolutely does not deserve this new revenue stream.

Healthcare in England deserves an uplift in spending on it to around 10% of GDP but a new organisation or organisations - ideally non-profit, but not the NHS, should get it. If new clinics now need to be built in the community these might be the worthy recipients of new sources of money but they should not be NHS institutions. Local authority institutions, maybe, or a mezzanine layer of institutions outside the NHS taking its patients.

Margaret Thatcher, whose funeral was held yesterday, faced prejudice and discrimination in seeking selection as a Member of Parliament but she did not abdicate responsibility for herself.