WHEN TOOTHACHE strikes, it can be the most excruciating pain. The proverbial bad-tempered bear with the sore head was undoubtedly suffering from an infected incisor or malign molar.

The victim of such agony needs help. Should he be lucky enough to be on the books of a National Health Service dentist, the patient may look forward to avoiding the routine extraction which was historically the answer to the pain. Maybe a filling of the root canal will do the trick, in which case the dentist will hand over a bill which could be more than £60. If a more complicated course of dentistry is needed, the cost to the customer can reach £384.

A new pricing scheme, which comes into force next April, will simplify the charges but leave a simple filling costing £41. In this part of the NHS, treatment for the majority of people is not free at the point of delivery and it has not been since 1989.

Yet politicians continue to peddle the notion of a beneficent National Health Service which would be destroyed if there were any suggestion of money changing hands in return for treatment.

Patricia Hewitt, the latest Health Secretary, has been quick to trot out the same old untruths. Only last weekend, she defended the status quo in the NHS with the promise that: “As long as there is a Labour government, Britain is not going to move away from a tax-funded system of NHS, where we all contribute and where we can all benefit free at the point of need.”

If the point of need is a dentist’s surgery, only a quarter of adults will receive their treatment free of charge and, despite her use of “we”, Ms Hewitt will not be among them.

But she was not about to let the facts deter her from chanting the familiar sentiments that politicians still believe most voters want to hear. There was, however, good reason why the Secretary of State for Health should have resisted the urge to announce that her mind was firmly closed on the issue. For she was speaking in response to comments from someone who might be expected to have an opinion on the NHS worthy at least of consideration, the new president of the Royal College of Surgeons.

Bernie Ribeiro has marked his arrival at the top of his profession by declaring that the old NHS, funded largely through taxation, should be replaced by an insurance-based system. “If we’re going to have a healthcare system suited to the future, we’ve got to be prepared to invest in it. I don’t personally believe that can be done out of pure taxation,” he said.

The remarks may have had Ms Hewitt and the brothers and sisters at Unison reaching for the smelling salts but Mr Ribeiro is only speaking the truth. The public, given a chance to listen to a reasoned debate on the matter, would probably agree with him. After all, most people do not merely pay for dental treatment when they can get it on the NHS, they also pay prescription charges.

It was a wicked Tory government that first introduced a prescription charge of a shilling in 1952 and Labour, with a grand gesture, abolished it 13 years later. But the demand for drugs grew and the economy was getting stretched, so Labour reintroduced the prescription charge in 1968. The usual exemptions apply for children and those on income-related benefits but a majority of people will pay £6.50 an item for their prescriptions.

Since the advice of a doctor is often of little use without the medicine that he prescribes, this also gives the lie to the idea that treatment on the NHS is free. People may grumble about prescription charges, and for some people on relatively low earnings but with a need of several different drugs, the cost can be a significant burden. Nevertheless, most users of the NHS have long accepted the need to make this minor contribution for using the service.

The cost of that service could be unbounded. Increasingly sophisticated treatments and drugs, coupled with the extending longevity of the population, mean that spending on health could grow to meet just about whatever funds were available. This Government has demonstrated a willingness to prove, however, that simply giving more cash to the NHS is not the way to get value for that money.

For the past five years, spending on the NHS has been rising at roughly 10 per cent a year but the outcomes have been so depressing that the Government has tried to find a different way of measuring them. Much of the money has simply vanished into higher wages and increased running costs. A study by the Reform think-tank published last December gave a warning that, by 2010, the NHS would cost up to £20 billion more than it should for its level of performance.

A full insurance system may not be the only answer. Mr Ribeiro suggested that perhaps emergency treatment could be free with people looking to insurance to cover payment for other treatments. There will be numerous other possibilities but what is clear is that the MRSA-riddled NHS is not the model to provide 21st-century healthcare. Ms Hewitt may not be prepared to consider change but then it was not so long ago that, in her previous job as Secretary of State at the Department of Trade and Industry, she was lauding the achievements of the Phoenix Four at MG Rover.

She was taken in by an illusion there. She should not be hoodwinked again by those who insist that there can be no alternative to the NHS. It is not free now and it never can be, so we should find a more efficient way of paying for it.

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