Good healthcare for all? Not on the NHS

Under new local NHS plans, smokers and obese people - the undeserving sick - will be made to wait months for operations.

Rob Lyons

Topics Politics

‘The NHS was born out of a long-held ideal that good healthcare should be available to all, regardless of wealth. That principle remains at its core. With the exception of charges for some prescriptions and optical and dental services, the NHS remains free at the point of use for anyone who is resident in the UK.’ So says the NHS Choices website itself. But if you smoke or you’re a bit chubby, that statement is no longer true.

In December last year, the Sunday Telegraph reported that NHS bosses in Kent had decided that smokers who required ‘non-urgent’ operations, like hip replacement or cataract removal, would either have to quit before they could join the waiting list or take part in a 12-week smoking cessation course. People with a body mass index (BMI) over 30 – classified as obese – would have to take part in a three-month diet programme in order to get on the waiting list.

This week, it seems the idea has spread. According to the doctors’ magazine, Pulse, the NHS in Hertfordshire is planning similar restrictions to the ones proposed in Kent, with smokers and overweight people kept off waiting lists while they mend their wicked ways.

These moves are primarily driven by money. After welfare benefits and pensions, the NHS is the UK government’s biggest area of expenditure, costing over £100 billion per year. While the Lib-Con coalition government has promised not to cut NHS spending, there is real pressure on local NHS managers to save money in the face of rising demand. One way to do that is to postpone operations. The trouble is that there is also a target that patients shouldn’t remain more than 18 weeks on a waiting list before getting their operations.

The answer is simply to make sure that some patients don’t make it on to the waiting list straightaway. This is, of course, perverse – reminiscent of stories from the old Soviet Union of how shoe factories made their targets for production even when the heel of the shoe was attached to the toe. The shoes were useless, but the factories made their targets because no one said the shoes had to be wearable. Presumably, NHS bosses in Kent and Hertfordshire will be able to claim that all the people on the waiting list got their operation on time, but that’s because some of the people who need the operation aren’t on the waiting list.

The decision to refuse operations is a disgrace, a complete perversion of the NHS ideal (even if the NHS never quite lived up to that ideal). Though the NHS is not an insurance system, where you or your employers pay in a certain amount per month in return for a particular level of health cover, there is a sense that almost everyone contributes to the NHS via taxation and should be treated equally when it comes to care. These new rules are the equivalent of an insurance company changing the rules when you decide to claim. If that was exposed in a Michael Moore documentary, many British people would simply see it as confirmation of the superiority of ‘Our NHS’ over the American system. Well, it’s happening in ‘Our NHS’, so where’s the outcry?

To be fair, some doctors do disagree with the new rules. Dr Mike Ingram, chair of the single-practice Red House Consortium and a member of Hertfordshire LMC, told Pulse: ‘Patients’ access to services should be based on the care they require and not on a discriminatory policy. I’m very worried about denying people care on the basis they are fat.’ The Patients’ Association has also been critical of these restrictions, while others have been exploring whether these rules are even legal.

Such restrictions aren’t new. As reported on spiked back in 2006, NHS trusts were already imposing such lifestyle-based rationing. Back then, however, there were some flimsy attempts to justify the restrictions on the base of medical outcomes. There’s little of that this time. Having created the NHS on the basis that lack of money should be no reason to deny someone healthcare, that care is now being denied on moral grounds instead.

We now have a simple division between the deserving and the undeserving sick, one that is broadly drawn. According to NHS figures, 21 per cent of UK adults smoke while almost a quarter of adults are classified as obese. Even if there is considerable crossover between the two groups, that’s still a very sizeable chunk of the population that would fall foul of this new-style health rationing.

Rather than admit to the limitations and failings of the NHS, health bosses have been able to exploit the moralistic climate created in recent years by endless health campaigns about smoking and diet, apparently with no complaint from ministers. It seems doctors, in the name of lifestyle manipulation, have forgotten that bit in the Hippocratic Oath to ‘use treatments for the benefit of the ill in accordance with my ability and my judgment’. Instead, it seems, patients can now look forward to remaining in pain or struggling with disability for months unless they fall into line.

Rob Lyons is deputy editor of spiked. His book, Panic on a Plate: How Society Developed an Eating Disorder, will be published in October. (Order this book from Amazon (UK). Read his blog here.

To enquire about republishing spiked’s content, a right to reply or to request a correction, please contact the managing editor, Viv Regan.

Topics Politics


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