What is going on at the British Medical Association? The trade union for doctors held its conference in Belfast this week, at which it passed a motion opposing the principle of charging visitors from overseas for using some of the services of the NHS.

Such charges were described by attendees as “a fundamentally racist endeavour”,  an “oppressive regime” and “racial profiling”. Doctors who warned of the obvious consequences of a global free-for-all on the NHS’s budget were reportedly booed by their colleagues.

This is completely unhinged. The NHS has limited resources with which to treat the increasingly expensive and complex health needs of this country. The BMA itself tells us all the time that this is difficult to do on the current budget.

“If the government seriously wants to ensure patient safety it must fund the NHS properly – we haven’t the money for enough staff, beds, and facilities,” said the Chairman of the BMA Council at the opening of this very conference. His audience sat there and applauded his speech, then went on to vote for a motion that would put further strain on the budget which he just said is over-stretched.

There is a huge clue to the responsibilities of the NHS concealed within its name. It is a national health service.

Declaring that to be “fundamentally racist” is ludicrous. Aside from the inherent racism of assuming its UK-resident patients to all be of one race, or assuming foreign visitors must be of a different race, the BMA appears to be indulging in a fantasy choice here.

The options available to us are not: 1) be really racist by asking foreign visitors to pay towards the cost of some NHS treatment, or 2) be really nice and treat the whole world on the NHS budget. They are 1) collapse the NHS by deciding it would be racist to pay attention to what it can afford, or 2) deal with the realities of running a service by fulfilling its stated purpose for the country within the available resources. For a doctors’ union to act as if the health service is a magical beast which can fulfil any wishes they might come up with is strikingly irresponsible.

It will also baffle most of the NHS-using and NHS-funding public. They have a lot of time for the health service, and for the doctors and other staff who work within it. They tend to side with them in any given dispute with politicians, and to believe that the BMA has the best interests of the NHS and its users at heart. But a row like this runs completely contrary to that assumption – and clashes directly with the more usual message from the union that the NHS is over-stretched and hasn’t got enough money to treat this country’s ageing and growing population.

There is already rationing of treatments for the residents and citizens who are eligible for treatment. That’s inherent to a health system like ours – particular drugs and treatments are not authorised by NICE as being sufficiently cost-effective; trusts make choices about their priorities, such as how many IVF rounds are available in their area or which specialist functions they will fund; individual patients are treated differently according to an assessment of their condition, such as the refusal of certain treatments to people over a certain weight. It’s often controversial, it’s always difficult, but people do generally understand that such rationed limits are in place for a simple reason: that even the NHS has limits to what it can provide, even if it would like to do more.

The limit on who is eligible for treatment is exactly the same kind of limit. And its reason is even more clear to the public: this is what the NHS does, it is inherent to its national mission, and without sticking to that mission then it will have to ration what it provides to each patient even further, or fall apart completely.

Calls by the BMA conference to remove that limit will come across as frankly weird or even outrageous to most people. It’s an act of pure wokeness which betrays that some of those active in the union seem not to think that it’s “our NHS”, as we are so often told, but in fact it’s their NHS, a playground in which to act out their performance of their political virtue, regardless of the cost to patients, taxpayers or the health service itself.