This week Unison, the UK’s biggest trade union, called for a halt to coalition reforms to the NHS. With spiraling waiting lists, and large budget deficits in many Trusts, the union argues that now is  "the worst possible time to bring in a major, untried, untested reorganisation".

Though the coalition knows better than to publically admit it, a major driver to the reforms is the sheers costliness on the NHS. According to the Institute of Fiscal Studies, health spending is second only to welfare, and accounted for over 18% of public spending in 2010-11. In the last 60 years, healthcare spending as a proportion of GDP has quadrupled (from roughly 2% to 8%).

With an aging population, and a constant expectation of more sophisticated treatments, the bill can only ever grow. The unspoken question is, how can we retain (and improve) the quality of NHS care while reining in costs?

To answer this, we need to address another, bigger and more important question: what, ultimately, do we expect the NHS to do? The theoretical debate around healthcare has historically been driven by two opposing philosophies: there are those who view health simply as freedom from disease and those, who like World Health Organisation, view it as “a state of complete physical, mental and social well-being, not simply the absence of disease and infirmity”.

Medical ethicist Norman Daniels advocates the ‘hardline’, as opposed to the WHO’s ‘expansive’ conception, emphasising the treatment of disease and disability. Healthcare, for him, can be distracted by notions of fairness and equality - it does not eliminate all differences, but compensates for restricted opportunity and loss of function, enabling people to return to their own life plan.

In spite of the difficult cases, Daniels’ model is the best alternative. The WHO definition is, of course, undeliverable, at least for transnational or even national institutions. It is an expansive view of the role of the NHS that is partly driving the ongoing increase in its budget, and this attempt by people, including the WHO, to broaden the role of healthcare to deal with all suffering suggests medicine is attempting to solve what are essentially metaphysical problems.

Medicine should only deal with disease and disability not all suffering. Take nose jobs as an example. Half of all requested nose jobs are paid for by the NHS. While it is important not to dismiss the possibly enormous psychological suffering some one may undergo due to unhappiness with their nose, this should not be treated by the NHS.

There is, however, a difference between ‘medicine’ as an activity of state and society, which should be seeking to treat disease and disability, and healing, a wider concept which has been for many centuries a speciality of religious traditions. Our desire for mental and social well-being is what makes us human, but it cannot easily or always be achieved by institutional provision. As research shows, and the church has long preached, wholeness and healing comes in the context of committed communities, the ability to move on from past hurts and a sense of purpose in the life.

The NHS can, and should provide medicine but healing comes from elsewhere.

Imogen Lawson-Cruttenden is an intern at Theos, and is reading Theolgy at Durham University