Deals on wheels

Observations on the National Health Service

Everyone knows that the demand for healthcare grows geometrically, while the supply expands arithmetically: in other words, that healthcare, unlike population, obeys sound Malthusian principles. But it has fallen to the British National Health Service - my heart swells with patriotic pride as I write this - to devise an entirely new means by which the contradiction can be resolved: rationing by non- availability of wheelchairs.

The system works like this: patients who need wheelchairs when discharged from hospital are required to hire them from wheelchair-hire companies (the cripples' Hertz and Avis, as it were). This is because the health service, needing to conserve its resources for more important things, such as managers' meetings and the NHS Modernisation Agency, no longer provides wheelchairs for patients.

Unfortunately, the worst accidents often befall the poorest people, those who cannot afford the hire of, let alone the deposit for, a wheelchair. But ours being a caring society, we have made provision for the financially challenged, differently abled: it is the responsibility of the social services to provide wheelchairs for them.

Now, we don't want any wheelchair fraud: that is, people getting wheelchairs who are not entitled to them. So the social services are duty-bound to carry out an in-depth investigation into the eligibility of each applicant; and just as Rome wasn't built in a day, so no form is ever filled in one. It takes a few weeks to decide whether someone is entitled to a free wheelchair.

Alas, entitlement is not nine-tenths of possession. Everyone knows that social services are strapped for cash, and quite often funds for wheelchairs - or, indeed, for anything else - do not exist. You'd have to be a health economist not to see the consequence of this: patients occupying acute hospital beds for weeks on end for lack of wheelchairs. Only last week, I encountered such a patient - he had already waited six weeks - and when I phoned social services, hoping to galvanise them into some sign of activity, I was told that the wheelchair specialist was on annual leave for the next fortnight. There was no one deputising for her, wheelchair allocation being such a specialist field. If extra money is ever allocated to the wheelchair department, it will be spent on a wheelchair worker rather than on wheelchairs.

So quite large numbers of people are lying in my hospital, which can hardly be unique in this respect, because they are waiting for wheelchairs. I rather naively thought this was a colossal waste of money, but actually it is a saving. If the patients who needed wheelchairs were moved out tomorrow, their places would be taken by people who needed operations, and operations cost money. Not only that, but a shortage of wheelchairs helps to enforce our hospital's no-smoking policy. If you want a fag in our hospital, you have to go outside, and if your legs are broken, you need a wheelchair. A £60 deposit and an agreement to pay £30 a week for four weeks will secure you one, but not even the best Havanas are as expensive as that. Keen as our patients are on cigarettes, they draw a line at hired wheelchairs.

Meanwhile, the majority of people with sick certificates have never had a day's illness in their life. From the government's point of view, though, it is better that they should be categorised as sick than unemployed. Welcome to the world of universal healthcare.