It cuts both ways

I’ve had lots of conversations on social media in recent weeks which boil down to the concept of personal responsibility. I don’t expect I’m saying anything original here, but I’m so frustrated by the double standards I see day in, day out, I wanted to write something down.

The starting point for this, again, is the ongoing debate around the UK government’s family cap. Many of us in Scotland have been puzzled about why the widespread horror around the family cap that has led to the so-called “rape clause” doesn’t seem to be felt south the border to the same extent, and in my experience the main reason cited seems to be the concept of personal responsibility. I could go on and on about this but it’s all been said before, and I think my last post on the subject of children’s rights made my feelings perfectly plain. So instead let’s have a look at this personal responsibility thing in a bit more depth. It’s an interesting exercise that throws up some anomalies.

Take the NHS. Much is written and said about the cost to the NHS of smoking, alcohol and obesity, but I’ve seen less about the cost to the NHS of more, dare I say, middle class activities such as extreme sports. Even less is written about costs incurred by missed appointments, unnecessary prescriptions and the like. I was curious about public attitudes to these things so I researched it a bit and I came across a very interesting survey conducted by the private medical company Benenden in 2015¹, which confirmed my suspicions. A few quotes:

“The survey revealed that the public will take a hard line when it comes to treatments needed as a result of excessive lifestyle choices. The number of people who believed making poor health choices, including, obesity, drugs or alcohol, should result in not being treated by the NHS hovered around 51%-53% in each case. Interestingly, injuries sustained from taking part in extreme or dangerous sports, or injuries from regular running on a tarmac surface were excused, with 61% and 55% of respondents believing these qualified for NHS treatment.”

“When it came to looking at their own attitude to the NHS and what they feel they are entitled to, the public was more relaxed. Three-quarters (75%) of those questioned admitted they didn’t consider the cost of a procedure or worry that the free treatment they were receiving could be taking treatment away from someone in greater need, despite 62% expressing concerns that the NHS was under strain.”

Commenting on the survey results, the medical director of Benenden said:

If the public was more aware of the cost of appointments, treatments, operations and prescriptions, and really took responsibility for their own health, using the NHS only when absolutely necessary, the crisis the service finds itself in today would be significantly lessened.”

One interesting point raised in the report was the question of prescription charges, a constant bone of contention between people in England and the rest of the UK. The reasoning behind the free prescriptions offered in every UK nation except England is very simple: the cost of means testing pretty much cancels out the money raised from charging for a small minority of prescriptions. There’s also the broader concept of universalism, which I’ve mentioned before on this blog, which holds that the costs of prescriptions and many other benefits are better funded from general taxation to prevent the barriers to access that could otherwise cause more expensive problems further down the line.

One argument I see used a lot against so-called free prescriptions is the perceived abuse of the system. A figure that’s often quoted is that NHS Scotland spends around £10 million a year on prescriptions for paracetamol which can be bought far more cheaply in any supermarket. Now there are some good reasons for this, for example people with some long term conditions may take large amounts of paracetamol and we all know the restrictions on buying these pills at the supermarket. But assuming, for the sake of argument, that some people do happily accept a packet or two of paracetamol or other common painkillers free on prescription, are we really saying that the answer to this is to abolish free prescriptions for all? Isn’t it conceivable that the answer is for these individuals – most of whom I would guarantee can easily afford their own paracetamol – to take “personal responsibility” for their choices and refuse the prescription, opting to buy the medicine themselves instead? Just as the answer to the cost of missed appointments, rather than the commonly proposed solution of charging for said appointments (and risking less well-off people facing the choice between seeing the doctor or paying the bills), is perhaps for people to remember to phone and cancel.

Why is it that the answer proposed by some to these problems (mostly, I would cynically observe, by those who can afford to pay) is to cancel the universal policy, instead of actual personal responsibility?

That is until we come to taxation. Judging by some of the reactions I’ve read to UK Labour’s proposal to raise taxes for those earning over £80,000 a year – and that’s a huge amount of money by any standards – personal responsibility stops when you get far enough up the income ladder. We’re constantly told that raising taxes on high earners won’t yield any more money because the wealthy will simply find ways to avoid it. Well what happened to the personal responsibility to pay your way in the society that you’re a part of?

You might feel hard done by having to pay more towards public services because you choose to pay for private health care or private schooling, and fair enough that is indeed your choice. But people on low incomes don’t have that choice, and they don’t have the choice to minimise their taxes either. New statistics published last month by the ONS² show that the poorest 10% pay around 42% of their income in taxes, compared with 34.3% for the top 10%. Net income for the poorest 10% (after direct and indirect taxes and including benefits) is on average £6,370 and for the richest 10% it’s £72,746. So if the poorest are expected to take personal responsibility not to drink, smoke or have more than two children in order to ensure “value for money” for the taxpayer, isn’t it right that the wealthiest in society also take personal responsibility to pay their fair share for the common good?





2 thoughts on “It cuts both ways

  1. On Twitter yesterday I noticed someone posted a list of charges being rolled out by the NHS in Dorset. A 10 minute phone consultation was £40, a 20 minute face-to-face appointment £80, and a 40 minute consultation £145. I can’t think may people could afford those charges, especially those who have long-term illnesses, pregnant women or the elderly who tend to need more medical attention. But this is the future of the NHS in England and, if we vote unwisely, in Scotland too.


    1. Yes I saw that too, and I saw it pointed out that not only would it push those who can pay up the queue, it will also push those who can’t pay downwards. It’s clear now that England is heading for a two tier health service. Those in favour of charging cite missed appointments etc. and claim that charges will make people “value” the service more and less likely to abuse it, but all the indications are that it’s simply about jumping the queue.


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