Most readers will assume that defining a healthcare “package” is a means of rationing healthcare resources. In other words, faced with the task of managing the limited NHS budget one option is to exclude some services altogether. But my case rests on a different interpretation of a package and involves asking a preliminary question. Before deciding how to ration, we need to know what to ration: What is the range of services relevant to the role of the NHS? What “business” is the NHS in? Is it the NHS's job to provide fertility treatment, physiotherapy for sports injuries, long term nursing care, gender reassignment, adult dentistry, and cosmetic surgery? Or should these services be provided by local authorities, voluntary agencies, or the private sector? The question does not rely on clinical judgment. It is about the boundary of a public institution's responsibilities. And it is a question which has been muddled up with issues of rationing proper.