If the NHS is like a soup-kitchen, it's in the best possible way.
'The NHS isn't some sort of soup kitchen where everyone can just pile in.' That, disturbingly, is the view of Dr Michael Dixon, the head of the NHS Alliance, a big fan of the current Government's plans for handing over much of the NHS to the control of GP-led consortia. His comment a few weeks ago was a response to fears that the new system would result in vital services being rationed. Last year, he tried ineptly to assuage fears by saying: 'just like in the recent Chancellor's Budget, that will mean some things being prioritised, some less so and some closing altogether." Oh good. How terribly comforting for those who rely on those 'things'.
His response in the same interview (with Health Policy Insight) to the 28% of GPs who opposed the Coalition slice-up of the NHS, was to call them 'malcontent or apathetic whatever' and to hint darkly at what awaited them: 'those who don't want to 'join up' may find that life is harder as a refusnik,' were his actual words. Deliciously jackbooty.
But perhaps the most telling quote of all (aside from the soup kitchen crack) was this: 'The NHS collectively... need to develop a "Dunkirk spirit"...' So, the NHS is a heroic but ultimately desperate attempt to save an army in retreat? And that is better than a place that gives necessary free support to those who need it? Brilliant.
Of course, Mr Dixon is just following orders, implementing the Coalition's grand 'solution' in the way that he feels will best serve his profession. But I think his attitude is wrong. I think his obvious disdain for institutions that feed the destitute is telling and I think it reveals a wrong attitude to what the NHS should be.
The NHS is not a soup kitchen, but it is very similar in many ways. I know what you're thinking: it's noisy, it smells funny (often of spirits), there are lots of drugs about and you're likely to meet some socially awkward, occasionally aggressive people. Fair enough.
It is also a service provided to people who otherwise would be in a lot of trouble and who often have no alternative but to rely on it. It provides something essential and beneficial and asks nothing in return. It's not always pretty, it involves some people with shocking attitudes and it may not deal with the causes of a lot of the problems it seeks to address, but at it's heart is a good-will that is deeply inspiring.
It is not there to make a profit, it is not run on strict business-principles (yet) and it is funded by many who will never make much use of it. But everyone is welcome. Even those who, because of their fervent believe that they will never sink so low as to rely on it completely, feel confident in their mission to destroy it. Or at least turn it into something else.
It is, like a soup-kitchen, a place you can go to get help without needing to prove you've earned it, and personally, I think it expresses some of the best qualities not only of Britain but of humanity.
But I will say this: I have been in some dismally mismanaged soup-kitchens and I have seen charity handed out with such bad grace as to negate its effect almost entirely.
If the NHS is like a soup-kitchen, its salvation lies not in treating it like a business but like a ministry of mercy. If there are, as we have been reminded again and again by stories of neglect and abuse, nurses and other medical professionals who are unwilling or unable to care for patients with compassion, if they feel they are above helping people with seemingly simple things at the most vulnerable and frightening times of their lives, then they have no place in the NHS, or any other mercy ministry.
It is precisely because we love the NHS that we should protect it both from the business-minded efficiency-mafia and all others who would make it less human.