Is the NHS really what we want?

Isn't the NHS wonderful? It was there when my [insert family member]'s [insert name of dreadful injury/organ failure/whatever] exploded/failed/turned green.

And yes, in terms of emergency treatment, the NHS is pretty good. Not so great at preventative treatment, overly target driven, but nonetheless, if I suffered a heart attack or other severe trauma, I would fancy the odds of survival to be as good or better here than in most other countries.

It's the N, as in National, that concerns me slightly. How much provision do we want to have dictated from the centre? How does a National Health Service fit into the mantra of localism? Indeed, should it?

I tend to the view that power should be diffused, that communities should decide for themselves the level of provision that suits. That might mean an emphasis on geriatric care in Eastbourne, on lung cancer in Pontefract. It might mean that Shetland does not fund IVF treatment, or that Powys doesn't fund cosmetic surgery. There are obvious difficulties, of course. How is the decision made, and by whom? How do you decide who is impacted by a decision? What minimum level of provision should everyone, regardless of location, have access to?

And it is interesting that none of the political parties want to touch the concept with a bargepole. I can see why - the prospect of the national press raising the spectre of a 'postcode lottery' is enough to send most sane people running for cover. Better to be safe than sorry, after all. And given the likely quality of any such debate - shroud waving doesn't begin to cover it - and the equally likely lack of backbone in those obliged to defend and justify the decision of the people, one might despair as to the prospects of a positive outcome.

However, money is tight, and obvious ways to cut spending on healthcare are somewhat noticeable by their absence. Anyone willing to come out in favour of cutting doctors? Nurses, perhaps? Cleaners, anybody? The cost of drugs has been closely examined already, PFI deals for new buildings place an extra burden on the budget, and miracle cures come at miraculously high cost.

So it comes down to, what do you want, and how much are you willing to pay? And until someone is willing to break the 'circle of reassurance' (the NHS is safe in our hands), I won't be holding my breath in anticipation of a meaningful debate.