In discussing the current pressures on the NHS, Alderwick points out that there cannot be a single definition of an ‘overwhelmed’ health system.(1) Rather, the performance of the health system has to assessed in the context of contemporary values and expectations.
However, can this contextual assessment be reduced simply to the NHS’s ability to provide people with the ‘care they need’? The idea of a person’s ‘need’ is usually taken as obvious. But, is it really so simple? A need has to be distinguished from a want. And, in the words of Lady Hale (former President of the Supreme Court), ‘we cannot always have what we want’.(2)
One definition of a ‘need’ is ‘what is essential for the ordinary business of living’.(3) Apart from healthcare, many other services (e.g. roads, security, education, etc.) are also essential for daily life. Given that public resources are inescapably finite, we have to be realistic about what we can expect from the NHS. A change in approach might help. Perhaps, we should start thinking about what NHS services are not essential, so that we can then focus on real needs. This might lead us to a better understanding of an overwhelmed NHS.
1. Alderwick H. Is the NHS overwhelmed? BMJ. 2022;376:o51.
2. Aintree University Hospitals NHS Foundation Trust v James [2013] UKSC 67, [2014] AC 591 [45].
3. R v Gloucestershire County Council, Ex p Barry [1997] AC 584 (HL) 598G (Lord Lloyd) .
Rapid Response:
What is a 'need'?
Dear Editor
In discussing the current pressures on the NHS, Alderwick points out that there cannot be a single definition of an ‘overwhelmed’ health system.(1) Rather, the performance of the health system has to assessed in the context of contemporary values and expectations.
However, can this contextual assessment be reduced simply to the NHS’s ability to provide people with the ‘care they need’? The idea of a person’s ‘need’ is usually taken as obvious. But, is it really so simple? A need has to be distinguished from a want. And, in the words of Lady Hale (former President of the Supreme Court), ‘we cannot always have what we want’.(2)
One definition of a ‘need’ is ‘what is essential for the ordinary business of living’.(3) Apart from healthcare, many other services (e.g. roads, security, education, etc.) are also essential for daily life. Given that public resources are inescapably finite, we have to be realistic about what we can expect from the NHS. A change in approach might help. Perhaps, we should start thinking about what NHS services are not essential, so that we can then focus on real needs. This might lead us to a better understanding of an overwhelmed NHS.
1. Alderwick H. Is the NHS overwhelmed? BMJ. 2022;376:o51.
2. Aintree University Hospitals NHS Foundation Trust v James [2013] UKSC 67, [2014] AC 591 [45].
3. R v Gloucestershire County Council, Ex p Barry [1997] AC 584 (HL) 598G (Lord Lloyd) .
Competing interests: No competing interests