The suggestion, then, by the South Central Priorities Committee (one of those Orwellian-sounding entities with which the NHS now pullulates), that the prescription of Viagra or other similar drugs for erectile dysfunction on the NHS should be restricted to two tablets per month, on the grounds of economy, is in contradiction with the system’s founding principles: that health care should be free at the point of usage. After all, sex life is part of health, and to enjoy a better sex life is to enjoy better health.
The problem with the WHO’s definition, of course, is that to deny anything that anyone desires is, likewise, potentially in contradiction with the system’s founding principles. If I pine for an expensive car that will improve my social status, and if social status (as it has been suggested) is a determinant of health, then it follows that I should be prescribed that car by my doctor on the grounds of health.
Impotence may be caused either physically or psychologically. A man may fail to desire any longer the woman he happens to be with; these things happen. Should, then, the NHS provide the man with someone whom he does desire, by setting up a call-girl service?
Lines have to be drawn somewhere, of course, but unfortunately the world is not divided into nice neat categories for the convenience of line-drawers. Almost all phenomena of any importance occur on a continuum, and so where to draw the line has long been a matter of judgment rather than of discerning clear, natural demarcations.
The NHS has long limited access to cosmetic surgery. The desire for such surgery ranges from that for the correction of obvious gross disfigurement to the merest vanity. It also encompasses madness – those who believe themselves to be disfigured by a feature that to everyone else appears perfectly normal, but for which they demand surgical correction: a correction that never satisfies, and leads to further demands for further correction, and so on ad infinitum. In such cases, suicide is sometimes the outcome.
Cosmetic surgery in the NHS is performed, then, only after an investigation of the person’s reasons for seeking it, and of his psychological stability. Those who are not deemed operable under the guidelines have to seek surgery privately; and even the mad will usually find a surgeon willing to operate on them, a partial (but only partial) confirmation of George Bernard Shaw’s cynical dictum that if you pay a man to cut off your leg, he will. I have known some sad cases of people who have devoted their lives to saving money for operations that never satisfy them.
The question, then, of whether to restrict the availability on the NHS of Viagra and other such drugs is a sensible or humane way to economise is not susceptible to a definitive answer. That economies in the NHS must be made seems certain: the increase in expenditure on the NHS between 1997 and 2007 is equal to about a third of our national debt, and may therefore be said to have played a large part in causing our current crisis.
The cost to the NHS of Viagra is about £78 million (it is a fair bet that the vast majority of those prescribed it do not pay prescription charges). This is about £2 per head of working population per year, the population that is least likely to need the drug. I have no idea whether, if a charity were set up to solicit voluntary financial contributions to subsidise the sex life of others, it would be able to collect £78 million. I suspect not.
But in the context of NHS spending, £78 million is small potatoes. I think it may safely be said that at least it makes quite a lot of people happier, and that therefore it does some good. The budget of the NHS is over £100 billion and needs far more drastic pruning than trimming amounts paid for medicines will achieve.
The obvious candidate for pruning is the wage bill. Those who are highly paid should have their salaries significantly reduced (as has been done in Ireland), particularly those who are not so-called front-line workers. All directors of diversity should be summarily dismissed. Directors of anything should have their salaries and allowances halved; management consultancy in the NHS should henceforth be a criminal offence.
If these proposals were met by strikes, the true purpose of many workers in the NHS would stand revealed: not public service or the health of the population, but the health of their bank balances. And at least my proposals are much sexier than those to limit the prescription of Viagra.
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