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Hello and welcome to a special edition recorded at the Nuffield Trust Summit,

the annual conference that does a lot of high-level agonising about the National Health Service.

The NHS has long been looked at as a moral triumph and used to be regarded as a medical one.

Compared with equivalent countries,

it still scores high on fairness, but low, very low in some cases, on outcomes for its patients.

We spend about average on health care, but are very nearly the worst, for instance, on deaths that could have been avoided. And is it that fair? Free at the point of use

doesn't guarantee health equality. The best off amongst us have on average 19 years more

healthy life than those regarded as most deprived. Dozens of health trusts are now looking at

computer programs that prioritise patients on social as well as

medical grounds. It's already happening for a million people in the Midlands. It effectively means

that poorer people get pushed up the list. The middle class will wait longer. If you're fat or a smoker,

you may well be promoted ahead of those who aren't. Practically, it's a question of who gets treated first.

Philosophically, it's a collision between competing notions of equality and fairness.

Should we care more about equality of outcome, being equally healthy,

or equality of access, treating everyone the same?

What actually is the ethical purpose of the NHS?

That's our moral maze. Our panel, Mona Siddiqui, Professor of Islamic and Inter-Religious Studies at

Edinburgh University, the commentator and campaigner Inaya Fulharin Iman, the historian Tim Stanley,

and Matthew Taylor, whose current role, central to this issue, is chief executive of the NHS Confederation.

Ladies and gentlemen, your panel.

Matthew, if the NHS is the nation's religion, you're one of the high priests. Where are you on this?

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