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Josie Cunningham's £4,800 NHS Boob Job - Money Well Spent?

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I am going to try as hard as possible not to turn this into a diatribe against vanity, wasted taxpayer's money and the entire NHS philosophy. This is the story of an aspiring model who received a purported £4,800 breast enlargement on the NHS (enlarged to 36DD if you're curious) because her 'flat chest' was ruining her life. In her words: "I could never go on holiday as I lived in terror of ever being seen in a bikini and could never set foot outside without a padded bra." I dare not doubt Ms Cunningham's sincerity for a second - that is not my place - but it is clear to see that there is something terribly wrong about all of this.

What could our struggling NHS have bought with £4,800? Pick up a copy of any respectable paper these days and you are likely to encounter an article about bed shortages on the wards, so it is interesting that the money spent on Ms Cunningham's op could have bought four bed days of high dependency paediatric critical care; 19 excess bed days and 50 outpatient or A&E attendances. In terms of resources, £4,800 could buy 590 pairs of disposable gloves, 126 catheters, and - in a touch of morbid irony - four months of Herceptin treatment. I hasten to add that my analysis of this situation is not entirely alarmist. I am fully aware, of course, that £4,800 is a drop in the vast, bottomless ocean that is the NHS budget. We have not scuppered our health service at the foot of mount silicon and its equally well-formed neighbour. What we have done, however, is to send out a very dangerous message to GPs and prospective patients.

But what is this I hear? Her life was a nightmare before the operation! cry the indignant masses in unison. That may well have been the case, but let us follow this kind of thinking to its logical conclusion. Should the NHS be forking out to satisfy any demand however irrational as long as their little QALY equation is favourable? And what about the demands of the unseen patients whose health suffers because of overstretched staff and resources? Surely it is the reasonableness of the demand that is important in these situations. If a patient comes into the GP clinic and complains that their right hand is conspiring with their left foot to kill them and that they need immediate amputation of both rogue limbs, the GP would not (I hope) refer the poor soul to the surgeon. They would most probably recommend therapy and anti-psychotics. I am not here suggesting that women who are suffering from a mood disorder as a result of the size of their breasts should be prescribed anti-psychotics. The analogy was intended merely to illustrate the following: at what point does the request become unreasonable enough for us to try to tackle the underlying cause of the request? To me, at least, it is clear that what Ms Cunningham needed was some help tackling her body image issue and not a surgeon's knife.

The blame does not lie with Ms Cunningham; she is the beneficiary (or casualty) of a broken system. Somewhere along the way, the NHS has begun rewarding unreasonable or exploitative behaviour. When we are rewarded for certain choices, we are bound to make them over and over, being the rational creatures that we are. In fact the most rational facet of Ms Cunningham's decision was her taking advantage of a readily available resource. The onus is on the bureaucrats and gatekeepers to refuse to set precedents for potentially damaging future attitudes, rather than making a boob of it at every available opportunity.