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The moral purpose of the NHS was clear to its founders - it should be free at the point of delivery, be based on clinical need, not ability to pay and should meet the needs of everyone. These 3 principals have guided the development of the NHS over more than 60 years and remain at its core, but for how much longer? With an increasingly aging population with multiple and often chronic needs the NHS is facing a 拢30 billion black hole by the end of the next decade. 15 million people in England have a long term health condition and 70% of the NHS budget is spent caring for them. The NHS in Scotland in the past 3 years has spent nearly 拢230m on drugs just to treat diabetes and obesity. In Wales 3 health boards have been warned about a 拢60 million pound overspend while at the same time it's claimed the Principality has the worst waiting times in the UK for life saving diagnostic tests. In a letter to the Times this week a high powered group of doctors, including the leaders from 4 royal colleges, says that the status quo is not an option and that fundamental reforms, including cutting services and charging for others, should now be considered. The NHS is woven deep in to the psyche of our nation, but are its core moral principles still valid? Is it still fair that those who've taken least care of themselves take most out of the system? Can we still afford the moral hazard that it doesn't matter what you do to your body; the NHS will always be there to bail you out? Should health care be rationed? Ill health is often linked to poverty - is it fair to expect the poor to pay, for example, for visits to the GP? Is it moral to defend a set of principles at the expense of making brave decisions in the interest of the country? Moral Maze - Presented by Michael Buerk

Witnesses are Dr Louise Irvine, Thomas Cawston, Dr Richard Cookson and Sir David Nicholson.
Produced by Phil Pegum.