Anna Quigley poses the question whether the “irresponsible” have a right to NHS care?

With the NHS facing tighter financial constraints, there is an argument that people who do not look after themselves should have to pay for treatment, or wait longer.

In David Cameron’s “big society”, there are signs of a changing public attitude, marked by an unwillingness to pay for the “irresponsible” actions of others.

For example, if someone injures themselves because they are drunk, why should everyone pay?

It is not clear how this would play out in the NHS but in a recent survey two thirds of respondents agreed that people have a responsibility to keep themselves healthy and 50% say the NHS should be able to limit the treatment.

However, it does not yet mean the public wants to penalise those who do not take the best care of themselves. Only just over a fifth of people support the idea of giving less priority to that sector.

There are budget constraints, although the indications are that the NHS budget will be protected.

While the public seem to think budget cuts will be enough for efficiency savings it could be quite different in a few years’ time when people are waiting longer for their operations.

The first step is to be honest about the scale of the challenges ahead because many people do not appreciate the scale of the situation and consequently the need to prioritise.

However, once they start feeling the pinch, their response could be strong. Any delay in this debate may risk public support for the NHS in the future.