The end of the NHS as we know it?
Monday, April 30, 2007 
'TOO FAT FOR NHS SURGERY' screams the front page headline in today's Daily Mail. "Millions of patients could be denied some NHS treatments because they are overweight or smoke." (Full story HERE.) I am one of several people quoted but I was particularly taken by the comment from Joyce Robins, co- director of Patient Concern, who said:
"A national health service should not be deciding on who is worthy of treatment. This is a slippery slope. Do we next decide that those with criminal records should be denied healthcare? These people have paid into the system all their lives. They will find it hard to understand why they must pay for someone to have their fourth child or for those who injure themselves in dangerous sports while they are excluded from the service. It may help trusts balance their budgets but could cost society far more. Deny a much needed new hip and the patient will become crippled and the cost of caring for them will soar. It makes no sense."
I am all for people taking more responsibility for their health - which could in the future include paying a premium for healthcare - but politicians have to be straight with us. If that's the path they wish to follow, it's the end of the NHS as we know it and health secretary Patricia Hewitt should admit it. Meanwhile, denying treatment to people who have effectively paid into that service all their working lives would be legalised theft. But that wouldn't be a first for this government, would it?
Reader Comments (6)
Although the focus of this story is obesity and whether NHS patients should be precluded from treatment, the controversy does raise wider issues in terms of people taking some responsibility for their own health.
The NHS does have to prioritize its resources and so as an example would it be unreasonable to deny or withold a liver transplant to an alcoholic who refuses to repent or give up the bottle?
My own father, who during his life smoked about half a million cigarettes, suffered terribly with clogged up coronary arteries. Even up to and after his heart bypass operation he was still smoking!! Had I been his heart surgeon the conversation would have gone like this "I'm sorry Dad but I'm not going to perform this operation until you quit the fags. Unless you stop smoking you're wasting everybody's time and NHS resources in the process. Just what is the point if you're going to carry on smoking yourself to death? If we're going to use thousands of pounds of NHS resources to try and save you Dad then you've got to help yourself. Let me know when you've stopped!!"
The Daily Mail would have had a field day and who knows, perhaps Dad would have stopped smoking before going on to suffer a number of heart attacks, a stroke and an early death at the age of 58 years.
So, yes, the NHS is morally within its remit to be careful with its resources and to make judgements in cases where the patient refuses to contribute to their own wellbeing.
The NHS was set up on a non-discriminatory, first come, first served basis. If the NHS now wishes to discriminate on any basis, then it is no longer the NHS. Breach of its principle of non discrimination can only lead to a minefield of perceived inequity from prioritisation of resources (why should resources be used to allow expectant mothers the option of a home or a hospital birth) to the difficulty of evaluation of probability of favourable outcome (why would a non smoker of a weak, negative character necessarily benefit more from surgery than a tough minded smoker). If Patricia Hewitt had an ounce of integrity she would already have resigned.
I'm all for it... sort of. On the basis that the more grotesque the crimes of government (please note I am not specific to "this" government) the sooner the day that resistance will reach critical mass.
The date of the NHS slippery slope was July 5th 1948 which, incidentally, is also the date of the "thin end of the wedge".
If the state provides the service and the quantity and quality of the service we each receive has no bearing whatever on the amount we each have to pay for it then the state should have a lot of incentive to try to prevent bad health. This also obviously leads them to think that they have a right to dictate to us how we should live. I am certain those who clamored for it's creation were well aware of this. It was a socialist program and it was pretty much modelled on Soviet lines and was thought to be one of the easiest of socialist programs to foist on us.
Another radical thought, if the above hasn't satisfied, is that if healthcare were provided on a totally voluntary basis it is highly doubtful that a hospital would turn away a patient who wanted some kind of care even if they fully intended to continue smoking or being overweight or whatever.
Simon on the next to last sentence of your piece I am somewhat amazed at your amazement. "Legalised theft" is pretty much a definition for taxes isn't it? Firstly there would be no need for the threat of violence to be there at all if the payments were voluntary. If they are not voluntary then they are coerced. If they are coerced then that is theft. Secondly there are many people without children who attend state schools who pay taxes that are used for "education". There are an awful lot more people who, whether it was "in their name" or not, have contributed funding via taxes for the invasion of Iraq. There are lots of people who help to fund opera who hate it with a passion. I could go on but I think you get the idea.
I have to disagree with Robert - no surprised there. Smoking related illnesses cost the NHS £1.5 billion, yet around £9 billion is levied in taxation from the smoker. I have little doubt a similar case could be made for alcohol.
So is you want to talk about morality then lets talk about withholding treatment from people who've paid enough EXTRA tax to pay for their treatment several times over and use those resources to treat someone who HASN'T paid extra tax to pay for an injury incurred through a non-taxed, but higher risk, activity.
I think we're on the cusp os a fat tax i.e. extra tax on fatty or generally unhealthy foods - which will only be adding insult to injury.
Tell you what, lets lift all the tax from booze and cigarettes and I'll use all that money to take out private health insurance and then the NHS can moralise all it wants (and then treat me anyway under a private program).
I agree with Rob on this. I have just recently been looking around the Forest web site - merely because I wondered whether, as a smoker and if I get denied treatment because of it, I have the right to demand back all the money I have paid in to fund some luxury private treatment. I believe that the NHS should not go down this route, otherwise they will find themselves at them end of some very expensive class action law suits.
I also agree with Rob on this.
There is no balance to this governments set of scales - they don't care about your health just about their wealth.