The public is pretty clear-eyed about the strain on NHS resources of a growing, ageing population. According to the BSAS 2011, 44% of us accept that growing demand on NHS services may lead to future rationing of treatments, and a resounding 80% believe that the NHS will eventually experience sufficient funding problems to have to omit certain treatments altogether. As we contemplate making difficult choices about what the NHS can and can’t afford to do, it seems that we tend to want to decide who gets what at least partially on the grounds of their lifestyle, the risks they have taken and their relative level of responsible behaviour.
Our growing sense that personal responsibility should be rewarded, and excessive risk-taking punished, is not confined to healthcare – it is a trend that is mirrored in people’s attitudes to a myriad of other public services. In a world where we know that excessive eating leads to obesity and the risk of diabetes, or that borrowing more money than you can repay can lead to a spiral of poverty, we are less and less tolerant of those who increase the costs to us all by refusing to take steps to protect themselves and us from risk. In healthcare, this growing sense that those who pool our risks with us must take responsibility is more advanced.