Juvenal, as every schoolboy used to know, coined the term “panem et circenses” almost exactly two millennia ago to describe the way politicians bought votes with little regard for important issues of state. What goes around comes around: this party conference season has seen Labour, Lib Dem and Conservative Parties trying to outbid one another in their promises for the NHS. I am not suggesting that the NHS is mere entertainment even if party conferences are. The point is that NHS spending is becoming a bribe in the same way bread and circuses were.

Any amount of money can be thrown at the NHS, just as it could at the Roman games. And consuming more increases the appetite for more again. Somehow questions of value for money, compared with other ways in which our money can be spent, need to be honestly and realistically addressed. Does a Health service need to pay for people’s life choices or how they wish to look? Does it need to accommodate elderly, but healthy, people who have nowhere else to go?

Does it need to fund legions of lawyers, managers and compensation claims for real and exaggerated errors? Harold Wilson started this problem in the 1960s when patients became customers and could suddenly claim. Until then the only customer was the state and we all had to take our chances.

Emotional wool seems to cloud all NHS discussion. As it is all free to us individuals, we, naturally enough, only want the best even when the merely good would be good enough. For, roughly, the same treatment, big hospitals cost double cottage hospitals which double GPs. Scale does have benefits for specialism but also diseconomies. Only the hassle of big hospital visits, and car parking charges. keep us local.

The cutting edges of medicine, technology and techniques always cost more but some means of rationing will have to be found. Alternatively, alcohol, tobacco and fatty foods should be prescribed as bread and circuses were. Dying younger would keep NHS costs down and morale up.