England is the sick man of Europe, and the Conservatives would probably make it worse
Dear Andrew Lansley,
Today’s verdict that England is ‘the sick man of Europe’ must have really stung Alan Johnson. Labour have been in power for over ten years and despite countless initiatives, hundreds of millions of pounds in investment and numerous ministers having a crack at the problem, England is still in dire straits. The figures contained in the “health of the nation” report are terrifying and Labour’s insistence that the government can solve it all are just as scary. Sadly, you seem to agree that the government is the solution rather than the problem.
The report covering 15 EU countries does not hold back. Obesity rates in England are twice those in France and Italy, which has led to a rapid rise in diabetes and other diseases in an already ageing population. Teenage pregnancy rates in England – making up 7.1% of all births – are the highest of any country and more than double the average. Deaths from chronic liver disease are also on the rise. Cases of chlamidia have more than doubled since 1997 to 211 per 100,000 people. While obesity affected 23% of the UK population, the average rate was just 13% across the 15 countries in this report. Only the United States, Mexico and New Zealand have fatter populations than England – not exactly comforting, is it. To compound this, the report was released as it was announced that the number of alcohol-related deaths in England has more than doubled in the past 16 years. A total of 8,724 people died of conditions such as alcohol poisoning and liver cirrhosis in 2007, more than twice the 4,144 recorded in 1991. The number of young adults dying as a result of alcohol use has started rising for the first time in four years, with more than 300 people aged between 15 and 34 dying of conditions related to alcohol consumption in 2007.
Labour’s response is obvious enough: release another initiative, but bearing in mind how many different problems we are now facing – teenage pregnancy, STDs, obesity, alcoholism, liver disease – they’re going to need a lot of initiatives (not that this would necessarily stop them). This presented you with a wonderful opportunity to out-manoeuvre the government but, as it turns out, you agree with them. You said that “their complacent approach to promoting healthy life styles means that we have the worst record on obesity in the EU. The NHS is so over-burdened by Labour’s targets and bureaucracy that it can’t focus on the things that really matter – like reducing deaths from heart disease and drinking.” No no no no no. You are clearly of the opinion that government action is the solution to this crisis, which I find thoroughly disheartening. Yes, targets and bureaucracy are bad but why should the NHS be the frontline of attack? Why should my taxes be poured into wasteful government advertising programmes that achieve sod all? I have a better idea: why don’t you follow David Cameron’s lead and promote ‘personal responsibility’? Heard of it? It’s when people take control of their own lives. This can be achieved through a combination of incentives and disincentives. For example, you could tackle obesity by refusing to operate on those over a certain weight and making obese people contribute to their healthcare costs.
The point is, Mr Lansley, that the government cannot ’solve’ any of these problems. Socialists might delude themselves into thinking they can but I was hoping (perhaps a little optimistically) you recognised the inescapable truth that the individual is the only one who can make the important decisions in tackling these problems. You can ban small wine glasses in bars and you can start as many healthy eating campaigns as you want, but until you accept that the government must relinquish control and start giving professionals some leverage to use with patients while simultaneously making patients realise the consequences of their behaviour, nothing will be achieved.
Yours sincerely,
A.Tory
Witanagemot Blogs
“Why should my taxes be poured into wasteful government advertising programmes that achieve sod all?”
Because they provide secure, cushy jobs for civil servants and nice little earners for consultancy and PR companies, perhaps…?
Personal responsibility. Eat too much, drink too much, do too little? Really its your propblem, not mine, and no amount of legislation or
propaganda campaignsadvertising about excercise is going to change that. You can’t legislate common sense and you can’t beam it into people’s heads via the TV either!I’m confused. You rightly state that government can’t solve any of these problems, but then you offer some solutions that government might use to solve these problems. Your suggestion of “while simultaneously making patients realise the consequences of their behaviour” smacks of woolly liberalism. The idea that government can tell people how to think is surely anathema to conservatives?
The idea that government can tell people how to think is surely anathema to conservatives?
And yet it’s less nefarious than ZaNuLab’s efforts to legislate WHAT people can and can’t think!
“The idea that government can tell people how to think is surely anathema to conservatives?”
Yes. Which is why no-one here is suggesting it.
LfaT is simply saying it would be better to point out to people that their choices have inevitable consequences, and ensure that those consequences steer them in the right directions, without making other people pay for their lifestyle choices.
Julia M – it would be better to privatise the NHS, and let people make their own decisions. If people wish to pay for the consequences of their actions then thats fine by me. Can’t abide the woolly liberal lectures!
Alastair – if we privatised the NHS tomorrow, what would happen to people, like me, with pre-existing, chronic medical conditions? No insurance policy will cover a pre-existing condition which in my case, with MS, would lead to phenomenally expensive bills which I could not afford to pay. It would be different if I’d had private insurance from the age of 18 but you’re talking about privatisation and not time travel!
Thank you Julia for clarifying the point I was making.
Alastair, people being made to face consequences of their decisions is very different from the government telling them what decisions they should make. I believe in people making their own choices in life, I believe in personal responsibility, I believe that the state does not know best. However, the government still has a role in setting the boundaries in which people make those decisions and that is all I’m advocating.
And please do outline your plans as to how we would move from a state-run state-funded monopoly to a fully privatised NHS without tearing our health service to shreds – or are you one of those ‘blue sky thinkers’ who doesn’t feel the need to work within the bounds of reality when it comes to the options available to an incoming Conservative government?
To allow people to take personal responsibility is the democratic, sensible thing to do.
To allow the NHS to operate the way it feels best serves the public, is the sensible thing to do (without targets, without government health campaigns it would be run much more efficiently).
The causes of obesity, teenage pregnancy, STD’s, and liver disease are what need to be tackled. Many, if not all of these problems have been created by Labours’ benefit system.
We have a new social class in the UK. The “uneducated, unemployable, underclass”. A result of labour’s excellent education policies.
They are paid to sit around, eat, drink, have as many children as possible and have no moral guidance (the church used to keep the underclasses in check in days gone by).
The more of these vices they manage to cover, the more they get rewarded, nannied and paid… therein lies the problem!
LFAT, I think you miss several points.
1. Teenage pregancies is a direct result of the extra moolah that single mothers get. As a proportion of potential income of a woman with a bit of ambition and skills, it is only small (so they stay in work or get married), but for unemployed dead enders it is huge amounts, lokk at e.g. The Netherlands – no benefits = very few single mothers.
2. As long as fatties and smokers and drinkers have paid their taxes which finance the NHS, why should they be denied treatment? If you rule out treatment for smokers and drinkers, then by rights you ought to at least scrap alcohol and tobacco duties.
3. ‘Personal responsibility’ is all well and good, but where stop? Somebody who breaks a leg playing rugby or chops his finger off doing DIY is just as much to blame for his own misery, so by rights the NHS shouldn’t be treating them either.
Sue, I agree that this is part of a much broader problem with attitudes and values within society, but if the government – Labour or otherwise – think they are the ones can who change attitudes and values then we’re in for many more years of wasted taxes.
Thanks for the feedback, Mark:
1. I didn’t cover teenage pregnancies here because it’s not really a question for the Shadow Health Secretary, but point taken.
2. People should be supported if they are struck by illness, not if they inflict illnesses and diseases on themselves.
3. Breaking your leg is not an illness or disease! I’m talking about scientifically proven, well documented and well publicised links between behaviour and disease. The list is short (as it should be) but it certainly includes the link between stuffing your face with food and obesity, hence the restriction of treatment.
I never said people shouldn’t be treated as part of ‘personal responsibility’, merely that it IS UNDENIABLY WITHIN EACH INDIVIDUAL’S OWN CAPACITY to ameliorate certain unpleasant outcomes. Sure the NHS *may* be able to save you from lung cancer and if you get it, it should, but it may not have the ability to save you and even if it does the process would be horrifically unpleasant. Ditto fatties and heart attacks. It is your responsiblity, like it or not, and it is within your own ability to reduce your chances of something unpleasant and potentially fatal happening to you. End of.
But also remember that *everybody* dies. Sooner or later, we all go…
we have a health model where both demand and supply side are effectively government monopoly. a simple and effective change would be to make the supply side competitive, but personally I think this would be silly unless patients were free to choose who and how they pay. If you want to keep the current “free for all” then this could be achieved by a system of tax credits – but I would much prefer lower tax and proper competition on the demand side. I would also accept the realism that goes with change, and that there would have to be transitional provision for existing patients.
Anybody like to put forward a case for keeping the current arrangements?
Shaun, I think you highlight a problem with the debate. You make an assumption about the causes of lung cancer. It may be a fact that a cause of lung cancer is smoking, but it is not a fact that all lung cancer is caused by smoking.
You may well make subjective choices which you think will extend your life, but the reality is that non smoking vegetarians also die from lung cancer and heart attacks
I agree, actually I think every time they interfere they make things worse. It’s human nature to rebel against the “system”.
The only encouragement any government should be giving is for people to become self reliant, which unfortunately means our generous benefit system has to stop.
Young girls who get pregnant for example, should either be the responsibility of their parents or have to enter some type of “Young Mums Group Home” where they are taught self reliance, a job skill and good parenting skills.
The education system needs a radical overhaul, in particular the way we treat those who are less academic. To go back to a Grammar/Other system would be better. That way, we could really concentrate on the brightest (of ALL kids) and the others could be taught far more practical job skills instead of making them feel like failures. Additionally,leaving room for late developers in either sphere to swap between the two.
The other thing that education has sadly been lacking (I know with my kids), is a competitive sports programme in schools. One of the highlights of my school (a long time ago) was the National inter-school sports days.
We had everything from obstacle races to swimming races. They were great fun and did not make people feel inferior if they lost. Part of growing up is learning to pick yourself up and try again. If we had sustained a great competitive sports ideal in schools, obesity would not have been so prevalent.
You’ll never stop kids having sex, it’s not realistic and it’s always happened but if they have a healthier attitude towards life and we allow them some self respect, many will change their way of life.
As far as the NHS service is concerned, I too believe if you have paid into a system you should not be discriminated against. When we start to discriminate on the grounds of weight or smoking you are entering dangerous territory.
What would be next? We won’t treat your skin cancer if you have sunbathed, we won’t save a junkie who has overdosed or alcoholics with liver failure, we won’t allow young girls who get themselves pregnant on purpose access to maternity care? What about if someone attempts suicide and but is damaged for life or someone who becomes wheelchair bound because they drunk and drove. What about gay men that get HIV? Sports people who get injured doing stupid sports or diabetes through overeating (those people are not always necessarily obese).
I personally could think of a long list of situations that could be deemed to be self inflicted,
What you are suggesting is downright discrimination!
Indeed not all lung cancers are caused by smoking but the vast majority of people who get lung cancer have either smoked or been subjected to second-hand smoke. Smoking does not *cause* lung cancer, it vastly increases the probability of developing it.
And yes, no-smoking vegetarians do die from lung cancer, but not in the same ratio as smokers of any dietary persuasion. The point is that people, rationally, should want to avoid anything that substantially increases their chances of a nasty outcome.
What Sue says.
More to the point, tobacco duties and VAT etc on cigarettes is over £10 billion a year, about three times what the NHS spends on smoking-specific diseases. If you are going to be ‘fair’ then either cut the duties or increase spending on smoking-related illnesses, but withdrawing treatment is just spiteful. If you chuck in smokers’ shorter life expectancy, smokers benefit the Exchequer by £20 billion a year in extra tax/reduced old-age pensions, which alone would cover one-fifth of the total cost of the NHS.
Ultimately *everything* is self-inflicted. Well, almost everything. Caught a cold? Should’ve warn a facemask. Dodgy stomach? Shouldn’t have eaten those peanuts on the bar. High blood pressure? Should’ve learned to relax…
The NHS, and medicine per se, aren’t and shouldn’t be there to pass judgement. I am arguing for getting people to properly understand the risks involved in what they do (and there are risks in every conveivable human activity) and the reality of what will happen if they fall foul of those risks. People seem to have odd ideas about what a Hospital can do until they experience one. Folks seem to have a glossy, high-concept, ER-style vision where Dr House can cure pretty much everything and still finish on a wry quip. The reality of a good spell on chemo or having your chest cracked open and organs rearranged to allow a surgeon to slice out a chunk of your lung are a million miles away from that.
Shaun, perhaps you have some statistics to back this claim of “the vast majority” up?
Okay biased one first:
Cancer UK: “Smoking causes almost 90% of lung cancer deaths.”
and BUPA: “Smoking – most lung cancers are smoking-related. Smokers are at much greater risk of getting lung cancer and passive smoking has also been linked to lung cancer.”
Sue, you can’t tell how much someone has sunbathed but you can tell how much someone has smoked or eaten, hence the ability to link their behaviour to their disease. Personally, I don’t think alcoholics with liver failure should be given a transplant on the NHS when so many other people are dying each year because they don’t get the liver they need, but that’s for another day
None of the other examples you gave involved diseases – crashing a car or getting injured playing sport are not behaviours leading to a disease so they are not comparable to obesity treatment, nor is a teenage girl getting pregnant.
Shaun, I think making people understand the risks of what they do is something that is sorely lacking in our society and in Labour’s social policies in general. The message that you can do whatever you want and the government will pick up the tab regardless is broadcast loud and clear every day.
That’s part of the message problem but the worst bit is that even if someone pays to ‘pick up the tab’ it will most likely be a thoroughly unpleasant process that will stand a good chance of leaving you in a worse way that before it started, even assuming that a medical intervention will be successful. You don’t owe it to me not to get ill, neither as a person nor as a taxpayer. You really just owe it to yourself and the people who care about you. Okay, you will definitely* end up dead but I’d rather go comfortably on a drip in a bed or dosed up on morphine rather than writing in increasingly untreatable pain or struggling for breath or flopping about on the floor clutching my flabby chest with my fat fingers. But that may be personal taste!
*technology may prove me wrong and deliver functional immortality! I live in transhumanist hope…
“technology may prove me wrong and deliver functional immortality!”
Nature got there first. But I don’t know about you, but I don’t fancy life as a jellyfish!
But I don’t know about you, but I don’t fancy life as a jellyfish!
Alzheimers or CJD can get you pretty close but without the handy living forever bit. Well, apart from leaving you quite literally demented!
LFAT, you are just looking for excuses to exclude smokers and obese people. No, none of the others involved diseases but nevertheless some could involve expensive lifelong medical treatment and care. Where’s the difference there?
If you are proposing the Government ignores these people when they need it, why should they contribute to the the NHS?
I smoke (but I’m slim) but besides having two babies I have never been in hospital, had an accident or even visited my GP more than 10 times in my life. I certainly have not got value for money. If I could have opted out and gone private with the money I had saved, I would have been able to afford the best of treatments.
The National Health service is an expensive rip off only there to serve the people the righteous think are deserving.
My other half recently moved out of a flat in London. An African woman had arrived from Holland very pregnant. He was neighbourly and said “Hi” and she later admitted to him that she had come to the UK to have her baby on the NHS and to get accommodation.
That is why the NHS is stretched. It’s serving too many people that have not paid into the system. That’s why cancer patients do without life saving drugs, even though they have paid into the treatment and fought wars for the country….
I say close the NHS. Allow people to either go private and opt out and those that can’t afford it will have to go to a mission or charity hospital.
Why should I be less deserving after paying in for 30 years, than anyone else?
I say close the NHS. Allow people to either go private and opt out and those that can’t afford it will have to go to a mission or charity hospital.
Again, I say explain what would happen to people like me, with uninsurable ‘pre-existing’ conditions like Multiple Sclerosis. How are we supposed to pay for our treatment when we can’t insure against it? After we’ve sold our cars, our houses, our possessions, how do we afford treatment or do we die in the street to usher in a Brave New Private World?
I’m actually quite angry about this. You are saying, if I get a smoking or eating related condition, like thousand in the UK will, I should not be treated, kicked out, even though I’ve contributed my taxes and paid NI for 25 years.
Yet, we give expensive drugs and treatment to immigrants with TB and HIV AIDS that arrive in the country, pay terrorists families huge sums of compensation, pay politicians extortionate expense accounts and pensions, run headlong into wars illegally and kill thousands of people, waste millions on computer systems that don’t work and generally (the Tories are guilty here too) ignore the general population when it comes to the EU which costs us billions to be part of.
This is all with taxpayers money, mine included and now you’ve decided to play God and say I don’t deserve to have a chance to live?
I’m certainly glad I decided to move to Spain if that’s what the UK is going to be like under the Conservatives, I want no part of it.
You, as a British Citizen should have as much right to treatment as everyone else under the NHS, that’s what it was designed for. It’s design wasn’t pick and choose.
If they’re excluding obese people and smokers, who knows, the next criteria when things get really tough, might be people with pre-existing conditions or birth defects.
This sort of attitude starts out small and then grows… that’s why its dangerous.
Get rid of all the useless civil servants, put the money in the NHS and there would be enough to treat everyone! Get priorities right, simple!
I’m actually quite angry about this. You are saying, if I get a smoking or eating related condition, like thousand in the UK will, I should not be treated, kicked out, even though I’ve contributed my taxes and paid NI for 25 years.
That’s not what I’m saying. I at no point have argued that treatment should be withheld. I don’t think LFAT is either. Government can no more ’solve’ Lung Cancer than it can legislate away Racism, Sexism or anything else. At most what it can do, I would argue, is advise people of the risks inherent their behaviours, make it clear that we will treat them on the NHS but make it equally clear that the treatment won’t be bells and whistles and Grey’s Anatomy but instead will, despite medicine’s best endeavours, be painful and traumatic and upsetting to your loved ones with a distinctly uncertain probability of success.
As a Conservative, I believe people have a right to make an informed choice (smoke and increase your risk of lung cancer, for example) and it’s government’s duty to inform that choice with facts (NHS lung cancer survival rates are 7% at 5 years from diagnosis), not anecdotes which support some paternalist moral position or pseudo public concern via a fake charity.
LFAT said
“2. People should be supported if they are struck by illness, not if they inflict illnesses and diseases on themselves”
3. Breaking your leg is not an illness or disease! I’m talking about scientifically proven, well documented and well publicised links between behaviour and disease. The list is short (as it should be) but it certainly includes the link between stuffing your face with food and obesity, hence the restriction of treatment.
So, he did actually say that.
Sue, you interpreted ‘restricting treatment’ as telling people to sod off and never come back in every circumstance, which is way beyond what I was suggesting. Obesity treatments are already withheld in some circumstances – for example, obese patients are often told to lose weight before they are given an operation and this is precisely the avenue that I would pursue. The types of treatment available on the NHS (e.g. stomach stapling) is also a serious concern of mine, as each stomach stapling procedure costs £7,000 – money which could be spent elsewhere.
Please don’t characterise my views as wanting to let obese people or heavy smokers just keel over and die because that’s very harsh. Like Shaun, I want personal responsibility put back on the agenda but there are many ways that this can be done. Like I said, there are in fact very very few situations in which a direct link between behaviour and disease can be drawn with a high degree of confidence.