NHS values concerning equal access for all, free at the point of need, are the core of its culture.

The values are held by staff and are reciprocated by the public. People feel good about a system that holds equality of access at such a high premium.

Better off people get free NHS care more than worse off people get the same free care

One of two paradoxes is that most of the public, who are not socialists, are very happy that the rest of society is organised on a different the principle. Food, housing, transport all cause us to reach into our wallets to pay when we consume. If you were to suggest that cars were to be distributed equally, paid for by taxation, people would be more puzzled than angry.

So we spend over £100bn on the NHS, through a principle different from the way in which we do other things. Does that cause people problems? Apparently, not at all. John Reid called this “the best gift that the British people ever gave to themselves”. They don’t give themselves very much, but this they love.

The second paradox is the fact that the principle is not happening in practice and nobody seems to be up in arms about it. So here is something that is really important to people to hold on to, and they get very angry if anyone touches it, but no one gets very angry that it’s not really happening.

Leaving aside the important outcome differences of life expectancy (which vary shockingly from one locality to another in every PCT) because there are so many factors external to health involved, the differential access to the NHS is really shocking. In most large conurbations you can draw a map of differential access and easily map that on class differentials.

So the paradox is that we have a value of equal access but the reality is that better off people get free NHS care more than worse off people get the same free care. We all know that, and are trying to equalise the access a bit, but the NHS vehemence in favour of the value is matched by the vehemence in favour of the reality.