Does Andrew Lansley really mean this?

PoliticsHome's transcript of Shadow Health Secretary Andrew Lansley's Sky News interview today:

Mr. Lansley said smokers and the obese may be told to quit before they can have access to surgery.

"We've got to have a more effective process for helping people make decisions and taking responsibilities.  If they don't take responsibilities for their own help, the demands will be progressively moredifficult to handle later on."

Smokers and the "morbidly obese" may be "told that they have to stop before they can have access to operations."  "We do have to understand that the demands are intense, will get greater as the population gets progressively more elderly and that will burden the NHS more.

"At the end of the day it comes down to people's willpower and decision making."

3.45pm: CCHQ have asked that we publish the whole of Mr Lansley's remarks believing that the context answers the question at the top of this post:

“We already have, in many places across the country, a situation where smokers, are told, very clearly, that they have to stop before they have access to operations.  Its dangerous for them and the same would be true for people, for example, with morbid obesity who are very, very heavily overweight.  It’s just not going to be possible, for example for them to have access sometimes to surgery, to deal with the heart failure consequences of their being very obese and therefore they’re going to have to think very hard about what the consequences might be for them. But I do hope actually what I’ve been saying in recent weeks is that we do need a much greater focus on delivering a National Health Service, which actually isn’t confined to what the NHS does but it will all of us actually think about how can deliver better health and taking greater personal responsibility.

No, we’re not going to put people to the back of the queue but we will make it clear that there’s no point, for example trying to have operations where people are also smoking and that just makes it all the more likely that they will have complications and a re-occurrence of disease. So people do have to recognise that they do have that specific responsibility, but, like with people with who we identify they have a lung cancer, which may be the consequence of smoking, we don’t say ‘we’re not going to treat you’, we should treat people and the NHS should be there for everybody, that’s in the nature of this great institution that celebrated its 60th anniversary. We’ve all contributed over our lifetimes, we all rely upon the National Health Service and we have a legitimate expectation it will be there when we need it.”

Comments

[David, let me have your babies]

Yes, because we Conservatives believe in making decisions based on medical priorities and not political demands.

We believe in freedom.

We love Dave.

We have always been at war with...

[Londoner]

I fail to understand why this man apparently has some caste iron personal guarantee that he will go into the cabinet in his present job. He appears to be politically unstable, as someone who was very much on the right when he first became an MP and now veering I don't know where.

[John Strafford]

If this is true it is disgraceful. Will Lansley ban car driving as it is dangerous and refuse to treat people involved in car accidents. Will he refuse treatment to anybody with an alcoholic related disease? Will he ban treatment to anybody involved in dangerous sports? If people are banned from treatment can they opt out of paying taxes for the NHS? Does all this remind you of anything?
First they came for the... and nobody spoke up for them.

[James Schneider]

Truly horrific. I hope DC slaps him down.

[Opinicus]

Yes. He really means it.

He can't even spell libertarian and he really means it.

Its not called the Nanny Health Service for nothing.

Actually, David lmhyb, I was thinking of the other Orwell:-
And Snowball looked through the window and he couldn't decide which were pigs and which were men.

Ed, when is the next ConHome shadow cabinet poll?

[Kirk]

If I'm being forced to pay to save their lives, why shouldn't they be forced to stop killing themselves?

[michael mcgough]

At the end of the day it comes down to people's willpower and decision making."

The decision who to vote for?

[John]

"If I'm being forced to pay to save their lives, why shouldn't they be forced to stop killing themselves?"

I quite agree. My wife works as a specialist heart nurse and knows of a consultant who has bounced a patient for a pacemaker because she came in stinking of cigarette smoke, having obviously just had a smoke.

WHY should we spend thousands of pounds operating when these people make no effort themselves. This is self inflicted!

In response to John Strafford 13:06
Generally car accidents are just that, however, why not start on the binge drinkers and get them to improve their lifestyle. It may save the NHS a lot of money if people started to take responsibility for their own health and lives!

[Simple Tory]

Insurance & Assurance companies penalise medical history, smoking, drinking, sports, post codes and goodness knows what else.
And we all sit back and moan about it but pay for it all the same.
Perhaps Lansleys' ideas are the 'nudge' that the unessarily unhealthy need?
S.T.

[Sally Roberts]

I hope what he means is that there will be tangible efforts made to stop smoking or lose weight - which is very different from saying that a level of success has got to be achieved. At least I very much HOPE this is what Andrew Lansley means (perhaps he can clarify?)
Smoking and over-eating are addictions and therefore it is incredibly difficult to give them up without resorting to Cognitive Behaviour Therapy of some sort. I for one do not want people to be allowed to die because their addiction proved too powerful.

[RobertD]

This is a very crude attempt to deal with a complex and critically important issue.

When the NHS was formed medicine comprised of dealing with infectious diseases, patching up traumas, maternity and paediatrics, and palliative care for those with degenerative and terminal illnesses. In these areas there is a strong case for community funding as most of the benefit falls as much to the community as to the individuals treated.

We now have a vast range of, increasingly expensive, treatments to make degenerative diseases more bearable and defer the end for terminal illnesses. We are also increasingly aware of the contribution of life style choices to the incidence and severity of these conditions. It is not just the impact of random chance. Individual choices have a significant influence, and individual preferences drive the demand for many types of treatment.

Just banning some people from particular treatments. or deciding that they are too expensive to be provided to anyone, is a crude and unworkable approach.

What is needed is to accept that for degenerative and terminal illness where the bulk of the benefit is for the individual rather than the community, then the individual should bear costs in relation to level of treatment they want and the lifestyle changes they are prepared to make to reduce risk. Whether the insurance is provided through the state or by private insurers ( or treatment is paid for directly by the patient) the cost should have a significant element of risk premium. If the risks are higher then the fat and smokers (and downhill skiers) can get treatment. They just have to pay more to reflect their lifestyle choices.

[J Hutchings]

This is a vote loser.
Threatening overweight people with discrimination is morally and tactically wrong. As a GP with large numbers of ovwerweight patients - often diabetics- I can tell you they tend to be very aware of it, struggle with it and are generally not very successful. Haranguing them won't make them vote for you.

Being overweight is partly age related, partly disease related, sometimes a sequel to medication, partly genetic, partly unknown.
The drugs to combat it properly do not as yet exist, despite the drug company hype of some present medications.

So just drop the whole topic. It is unpleasant, untimely and a vote loser.

[Norm Brainer]

Smoking, just like drinking is taxed extra to pay for the additional demand on public services (I refuse to comprehend that it's taxed to change behaviour) so I've no problems with them receiving medical treatment.
Not so sure how you would work that with regards to the obese - you can't tax food more and it's hard to tax lack of exercise.

[Sally Roberts]

J Hutchings you are right - it is a total vote loser! Can you imagine the capital the Left will make out of it - just when we were starting to get rid of the idea that we were the "Nasty Party"?!

[C List and Proud]

Vouchers to buy health insurance for all but ambulance, para-medic and A&E services. Insurance cos not allowed to disallow pre-existing conditions, but allowed to load premiums for lifestyle deficiencies. Mainly private GPs and treatment centres. That's what works everywhere else, we should have it here.

In truth, health is clearly a second term reform - read DC's intro to the conference programme - by then Lansley will have gone as there is bound to be one crisis too many for him to handle as he tries to babysit the NHS through those first five years before the big-bang reform hits in 2015.

[Allan McKinley]

" Hutchings you are right - it is a total vote loser! Can you imagine the capital the Left will make out of it - just when we were starting to get rid of the idea that we were the "Nasty Party"?! "

But will Labour be stupid enough to present themselves as wanting hard-working people to pay for those who appear to be unwilling to make an effort for themselves. I suspect that as a policy this would work better in Labour heartlands than in Tory (not that I think it is genius). Certainly, with Labour's recent touch they would end up alienating someone with their response.

[The Rifle]

I back Lansley 100%. Why should I help (through my taxes) pay for someone else's operation when they won't even help themselves?

There is only so much money to go around. I'd rather it be spent on people with cancer than people who cannot stop eating.

[Peregrine]

Allan has just encapsulated everything that I hate about this policy. Firstly the assumption that smokers are not hard working, nice one as it tars smokers with the brush of indolence.

Then follows the usual financial claptrap about the hard working (deserving?) people having to pay for the care of the indolent. I wonder where all the tobacco duty comes from? Do the indolent have special access to extra funds to pay it?

Don’t ask people, whether they be indolent or not, to pay an extra tax and then withdraw a service from them that is available to the non-tax payers. You may just find the tax payers just slightly more annoyed than you expect.

[Sally Roberts]

"I'd rather it be spent on people with cancer than people who cannot stop eating."

Many cancers are caused by obesity - and by smoking!

[Malcolm Stevas]

John Strafford writes:
"If people are banned from treatment can they opt out of paying taxes for the NHS? "
Well, let's hope so. Seems perfectly sound and logical, and one hopes it could be a precursor to dumping one of the world's biggest and least efficient sacred cows, the NHS. A society that continues to subsidise a feckless, criminal underclass with massive housing/unemployment benefits, and which in parallel subsidises and encourages their bizarre, unhealthy lifestyles then pays (with other people's money) for the deleterious health consequences to be remedied, is on its way into a black hole (Hah! topical, eh?). I'm astonished to see presumed Tories here who are apparently wedded to the continuation of massive State handouts to those with a death-wish; those who want to over-indulge in junk food or whatever should of course be entirely free to do so, so long as they accept the responsibility (and financial consequences) for their actions.

[John W]

When medical conditions which are very expensive to treat are caused by the ongoing actions of an individual it is not paternalistic that the individual is required to modify his or her behavior before treatment is given. This already happens with liver transplants for alcoholics.

It appears the out-spilling of bile on this site is no more than a pavlovian response to the mention of Andrew Lansley.

It is a perfectly conservative and indeed liberal measure to require people to take responsibility for their actions before they are able to demand a sacrifice from the rest of society on their behalf.

[John Leonard]

If he meant it SACK HIM!

[Cleethorpes Rock]

Surely the point is that, as a Secretary of State for Health, it shouldn't be anything to do with Andrew Lansley who doctors treat and when. We need LESS political interference in healthcare, not more of the same.

We've seen recently that Consultants are under pressure to bas clinical decisions on political concerns and even media headlines. For too long, we Conservatives have allowed Labour to use healthcare as a political weapon. That's why Labour refer to the NHS as "our NHS", "our greatest achievement" as if everyone's health is somehow at the whim of the benevolence of the Labour Party.

Lansley is right that people should take more responsibility for their health and wellbeing, but the best way to achieve that isn't through more Nanny Government!

[Richard Calhoun]

What business is this of Lansley's?

If you have paid your insurance it is not up to politicians to decide, it is a clinical decision

The sooner the NHS is taken out of State control the better.

[Sally Roberts]

What a thoroughly nasty post, Malcolm Stevas! Let's hope neither you nor any of your loved ones needs treatment on the NHS at any time - oh I forgot of course you or they wouldn't as it is only for the "criminal underclass"!! Shame on you.

[GB£.com]

Mr Lansley,

#1 Go and look up the total cost of smoking related illnesses to the NHS.

#2 Go and look up the total tax take on tobacco.

#3 Apologise to smokers, who are not just funding their own care (no burden to the NHS at all, it's all paid up front), but are additionally directly subsidising (tobacco tax) the treatment of thousands of others too on top the contribution they make via income tax.

Don't bite the hand that feeds you Mr L.

[David, let me have your babies]

A society that continues to subsidise a feckless, criminal underclass with massive housing/unemployment benefits, and which in parallel subsidises and encourages their bizarre, unhealthy lifestyles then pays (with other people's money) for the deleterious health consequences to be remedied, is on its way into a black hole

OK, what will will do after we've abolished the monarchy?

[Londoner]

Other additional benefits to the State from smokers, apart from tax revenues, is their shorter life expectancy (less pensions) and less likehihood of needing long term care into late old age (more likely to die quickly from cancer or heart desease before they get dementia).

But the reason many of us have reacted so badly to this is that it is the classic argument whereby State provision and control leads inexorably to more State interference and control over people's lives. You have to draw the line and not allow the State to "buy" people's personal autonomy. If you don't, it becomes just a series of utilitarian incremental steps before you get to totalitarianism and compulsary euthanasia.

As others have said, this does not prevent clinical (not politicians') judgements about the likely effectiveness of, say, chemotherapy of a cancer patience who has not given up smoking, or a liver transplant for an alcoholic who is still drinking. If there is a minimal chance of the treatment being successful it is better for the patient not to put them through it.

I think part of the problem with Lansley is that these sorts of statements fill the vacuum where once we had a distinctive Conservative health policy. He's not allowed, or doesn't want, to have one of those so he spends his time on this stuff.

[TC]

Lansley's full comments obviously put a slightly different spin on the story.

Regardless, I would just say one thing: if obese smokers are not going to be given treatment, then they shouldn't be forced to fund the NHS through their taxes.

You can't have it both ways. Either everyone contributes and they all get equal treatment, or people can choose to opt out and look after themselves.

And personally, I'd much rather go for the latter.

[Sean Fear]

" Why should I help (through my taxes) pay for someone else's operation when they won't even help themselves"

Because the people who "won't help themselves" have also paid for their (and other peoples') operations through their taxes.

It is grossly immoral for the State to compel people to pay for their healthcare, and then not actually provide it because it disapproves of the way they live.

[Helen Wright]

I bet he doesn't support refusing gays the extremely expensive treatment for AIDS and rectal tears, though, even though these are clearly related to their lifestyles?

Thought not. And nor should he make choices based on what disgusts him, either.

[John Leonard]

I will elaborate on my comment above based on the response from CCHQ.

There is a case for people to give up health damaging behaviour prior to surgery if that behaviour will put at significant risk the success of that operation. It's no more than saying don't eat for 12 hours before an operation. If the behaviour frowned on or not is going to possibly cause the surgery to fail then it is in not in the patients interest and I agree with that practice. It's common sense. It is also no big deal so if Lansley was alluding to this then it is so trivial it is irrelevant

However, if Lansley intended it as a pre-emptor to powers that allow some blanket excuse to for medical professionals to deny people treatment (for whatever reason) on a selective basis because people indulge in things not good for them then the list of those excluded becomes very long.

Not only would it include those who smoke and those who eat more than is absolutely necessary, then it could also include people who drink alcohol, people employed in the private sector who undertake dangerous activities, people indulging in sports and 'adventure' activities, those who drive over the speed limit, those who indulge in unprotected unsafe sex, take drugs for leisure purposes, involve themselves in criminal activities and so on.

It does seem ridiculous doesn't it?

Not only is anything less than addressing all health threatening behaviour in a similar ilk prejudiced and discriminatory but in doing so is divisive to the extreme and as such promotes the breakdown of our society rather than mend it.

Furthermore, the latter approach puts at question the purpose and viability of the NHS and if it is Lansley's intention to go down this route at all I have a simple response. Thank you but no thank you, give me back my NI payments (with pro-rata interest) and I will sort out my own health and pension arrangements. In such a scenario he could keep his 'Selective Health Service'.

For this reason David Cameron needs to think very seriously whether Lansley should keep his portfolio. This approach actually strengthens the arguments for those who would break up the NHS and in doing so opens the door for the sharks in the media to feast on thousands of stories of those who have suffered from being denied NHS treatment.

It seems to me Lansley is trying to make the NHS run before it can walk properly and most likely he will fall flat on his face. I do hope it is a soft landing because in indulging in such risky behaviour he could find that the NHS will decide not to treat his injuries!

[eu007]

If I give you money now for something in the future, and you change your mind later and tell me you won't give it to me, and then you refuse to give me my money back, that is called theft. I would end up in prison if I did that.

Anyone who would overlook this when its committed by the state is very dangerous indeed.

[Saltmaker]

So, basically, the PoliticsHome "transcript" was completely misleading and spun. Andrew Lansley never said anything remotely like "Smokers and the "morbidly obese" may be "told that they have to stop before they can have access to operations."

Shame on PoliticsHome.

[Teck Khong]

It takes a long time to understand what's good and what's bad about the NHS, and the NHS is the product of policy and not the progeny of medicine.

Unfortunately, the virtues and necessities of medicine and medical decisions have been sullied by politics. It would be far preferable for the user to connect more directly with the medical profession, instead of having layers of intermediaries.

Health is too vast a portfolio for a single person who has never worked in any of its manifold arenas, and some areas require sound knowledge of the technicalities that make up those specialties.

A non-medical minister needs a really strong and versatile briefing team to weather such storms.

Andrew Lansley should therefore not be castigated for his view of the difficulties facing the NHS.

[Malcolm Stevas]

Sally Roberts writes:
"What a thoroughly nasty post, Malcolm Stevas! Let's hope neither you nor any of your loved ones needs treatment on the NHS at any time - oh I forgot of course you or they wouldn't as it is only for the "criminal underclass"!! Shame on you."
What an oddly un-conservative post, Sally Roberts, and how sad that you've misunderstood/parodied my message. Do you regard the NHS as either a success story, and/or as something so fundamental to a civilised society that it's beyond criticism? If so, you have a great deal in common with the Left, for whom the NHS is indeed a sacred cow.
The NHS is an extremely expensive item, one of the most expensive things the UK taxpayer is obliged to fund; it constantly spawns such headlines as “Delays to NHS computer system could cost taxpayers £40bn”, and “Britain's booze culture (!) costs NHS billions,” indeed we are probably desensitised by this constant bombardment of information about the truly vast, space-programme levels of expenditure. Ignoring its origins in political grandstanding post-WW2 – taking gesture politics to new levels of unanticipated recklessness – what is it supposed to be for? It’s an organisation aiming to provide taxpayer-funded healthcare to everyone. Of course, if everyone had access to any and all of the best treatments available, the NHS would quickly bankrupt us. Therefore it should be made clear what is and is not available on the NHS. To pretend that everything and everyone can be treated equally is not just foolish, it’s a wicked lie. It seems to me that when people such as Lansley start to question NHS shibboleths this can only be a good thing, and it is disappointing (though not surprising) to see so many avowed Conservatives rushing to defend the great creaky monolith from “nasty” detractors…
My personal experience of the NHS, Sally Roberts, has been sort of OK, but not wonderful – not as impressive in its thoroughness and professionalism as I’ve experienced (with my family) in e.g. France and Germany. My younger brother’s experience was less happy: having been misdiagnosed by two successive GPs after experiencing stomach pains, he was eventually admitted to casualty with much worse pains, and after nearly three months of treatment (or non treatment? Who can judge? Since you’re just a taxpayer not a proper client receiving a service, they only tell you what they think you need to know…) he died of an illness that has a mortality rate of only 15%. I don’t think this biases me unduly against the NHS – the facts, historical, financial and logical, speak for themselves. It’s only one of many cash-guzzling facets of an essentially Socialist State, but it’s a particularly big and ugly one that needs drastic change by people with vision and guts. I doubt if Cameron & Co have these qualities; perhaps you know this and are sensitive about it, so rush to deflect any criticism of the NHS which is, by implication, criticism of Dave.

[snegchui]

One thing I find strange is the unwillingness of the NHS to do checkups. The NHS appears ready and able to respond to emergencies , very well in some cases, but seems unwilling to catch diseases at an early stage. unless funded by an employer, who usually asks a private company to do it.
I agree with posters who say there is a disconnect in the client/provider relationship, with the provider using information to its financial and political benefit.
But prevention also needs to go out into the school curriculum more. It's not rocket science and it's not expensive. Smoking increases the chances of painful and lingering death, binge-drinking causes painful lifestyle adjustments over 20-30 years (maybe less, I know of two sub-40 patients who died of liver failure recently). Eating well needs to be taught, what food-processing is needs to be taught. Badgering/nudging the supermarkets won't work, teaching youngsters high-salt snacks are better in moderation, especially if you are turkey-twizzling for lunch will cut demand for high-salt. This is why I think an accurate and consistent food-labelling regime is important.
If people are not aware of the choices they are making, or are unaware of the results of those choices, they are being deprived and exploited.

[C List and Proud]

Don't start from here. The NHS needs to be scrapped in its current form and replaced with an insurance based system modelled on - personal preference - Germany.

We're nicking the Swedish Education model, why not nick the German healthcare model?

I suspect cunning plan no 2579 here. Take 5 years of the same level of ever-higher spending under the us after 13 years of ever-higher spending under them, conclude no, sorry it didn't get any better really so we'd better do something else before you all die - see above - then go to the polls and hope the electorate like the personal responsibility agenda we have run for five years with schools and welfare.

I can see the message. It will be hard medicine, but it's got to be done. We have the vision - (and we believe in it, you know we do, really). Labour are more of the same old, same old.

Bit like Maggie in '83. Job needs doing, we're doing the job.

[John]

"I bet he doesn't support refusing gays the extremely expensive treatment for AIDS and rectal tears, though, even though these are clearly related to their lifestyles?"

Theres an idea!

[Malcolm Dunn]

Sorry I know some will call me 'unConservative' but I have no problems at all with Lansley's speech. I say that as someone who fights a tough battle against both nicotine and bcoming too porky!

[Malcolm Stevas]

Ideally I'd like to see the State get out of healthcare altogether, but that prospect frightens a lot of people for irrational reasons, so there's much to be said for "C List" 's "The NHS needs to be scrapped in its current form and replaced with an insurance based system modelled on - personal preference - Germany." The German system seems to work well, distinctly more smoothly and professionally than the NHS. I have some personal experience of it, and know doctors in Germany.
As for snegchui, when you write, "..prevention also needs to go out into the school curriculum more. It's not rocket science and it's not expensive. Smoking increases the chances of painful and lingering death, binge-drinking causes painful lifestyle adjustments over 20-30 years (maybe less, I know of two sub-40 patients who died of liver failure recently). Eating well needs to be taught, what food-processing is needs to be taught. Badgering/nudging the supermarkets won't work, teaching youngsters high-salt snacks are better in moderation, especially if you are turkey-twizzling for lunch will cut demand for high-salt. This is why I think an accurate and consistent food-labelling regime is important." I do wonder if you by any chance you read the Guardian... You seem to advocate exactly the kind of nannying, patronising, State-knows-best, time wasting, hugely expensive and ultimately doomed policies from which we have suffered for so long! Look, anyone who has failed to discover by his or her teens that smoking is both suicidal and distasteful, and booze can wreck your life if indulged to excess, is clearly a candidate for retrospective natural selection; and the kind of people with a propensity to binge on junk food to the point of obesity are unlikely to read the labels on food packaging - if they can read at all.
This kind of thing reminds me irresistibly of Sweden, and its 40-year experiment with Socialism; they came to their senses, sort of, after realising the country was going broke trying to regulate everyone's lives in the last detail, and that despite all the caring social education provided by the Thinking Classes for the proletariat, many of the latter stubbornly insisted on pursuing a brutish, uncaring lifestyle. Well, who'd have thought it!

[Passing Leftie]

Please don't change for me Andy Baby, stay exactly as you are. We need more of your straight Tory talking to let everyone know what you Tories are really about. Really, it serves those fat chain-smoking bastards right. We could even pay to watch them choke to death in A&E while the medical staff chuckle.

We can extend his excellent ideas:

* If you crash a car while driving too fast or under the influence of alcohol, no treatment.

* If you choose to indulge in a reckless sport (rock climbing, rugby or deep sea diving), no treatment.

* If you are stupid enough to get pregnant out of wedlock, or underage, no treatment.

* If you join an expensive drinking club and fall into a nearby river and land arse-first on a punting poll, no treament.

* If you are found to have a family pet lodged in a cavity, no treatment.

And beside lung cancer, many other cancers are caused by life style choices. So, add people who've got malignant melanoma from the sun, people who've got bowel cancer from too many curries, people whose septums have been damaged by class A drugs and those who've commited acts of moral turpitude and ended up with STDs.

When combined with his excellent plans to lift restrictions on food labelling, far more people will join the ranks of the obese, be refused treatment, and NHS costs will plummet!

The great thing is that rich fat smokers will be able to afford treatment from their own pockets, while the poor ones will die. This really is joined-up thinking.

[Malcolm Stevas]

Well, at the witching hour I spy this excitable trash from a par-for-the-course lefty who unwittingly spells out the inescapably logical case for removing the State from considerations of healthcare! Well done, Passing Leftie. So, you gonna provide some deeply rational "joined up thinking" in an attempt to conceal the utterly inevitable economic disaster that will ensue should fans of the NHS (yourself included, I dare say) and those too cowardly to dismantle it (insert any recent or near-future government here) continue to attempt to provide free-at-point-of-delivery healthcare to everyone, for ever...? Put up, or shut up.

[Opinicus]

Will the lemmings above even begin to think through their support for Lansley's idiocy.
If we follow the path that the NHS should not cover for self inflicted illness, have they even begun to think through the effect of this.

Almost all A&E would have to be paid for
e.g. All children with heads stuck in saucepans and All Road Traffic Accidents
All sports injuries
All Sexually transmitted disease
All maternity care
All mental illness caused by stress or life events e.g. bereavement
All foreign travel related illness

But of course we are not dealing with rational decisions carried to logical conclusions. We are dealing with the blind prejudice of the nation's puritans.

[snegchui]

Malcolm Stevas:
I can only assume you you have little or no education, certainly no training in logic. I dislike and distrust the Grauniad with a passion.
Prevention is better than the cure is a very good conservative principle. There are many things that people take for granted because it makes short-term sense, but on closer examination prove to be quite fallacious. Looking very clearly at cause and effect is is quite an art, and not one I have fully mastered. I don't know how many have. But this I tell, your so-called certainty is stupidity of the highest order. You are neither conservative nor libertarian, you are someone who is 50 whose thought processes died at 20. Go mate with a shrew and good luck may it do both of you. Your thoughts are of little value, if of greater self-pleasing pleasure to yourself.
Other countries look at our childrens' ignorance of portion control and balance as something horrific. Alcohol, France, US and Canada are much more prescriptive than us about alcohol-induced results and behaviour. Leaving a void of information of cause and effect is neither conservative or libertarian, it is asocietal. It is the warped thinking of a drunken Nietzshcean with no regard for anything but itself, and I use itself deliberately.
Before you can make responsible decisions, you must have the best available facts. You seem to wish to deprive people of facts. why is that?

[Passing Leftie]

Malcolm Stevas,

I wholeheartedly support your efforts to make the abolition of the NHS Tory policy. You and Andy are two of a kind.

The rest of us will live with the current system of free healthcare efficiently and inexpensively provided by the State, without making moral judgements about who deserves treatment.

[Gloy Plopwell]

NHS spending must be incresed by 12% a year, with stupendous momentum. It must be paid for first by extra borowing, heaped, and then with extra taxes.
We should raise extra taxes from all parts of the economy.

[snegchui]

Can we poop on your head, Gloy Popwell, to increase the rate of return from taxation? A most satisfactory activity in my opinion.

[Saxred]

Will he also ban all failed aslyum seekers and jolly foreigners? I don't think so, just the white working classes.

[grumpy old man]

This is not a health issue, it is a human rights issue. We're all going to die sometime. If people want to go to hell in a handcart, dying a slow, lingering death due to medical interference instead of a relatively quick one by their lifestyle choice, that is their decision. It's no good blethering on about nicotine and alcohol users when the substances are freely available and heavily taxed as an essential part of Government revenue. In both cases, addicts have paid the govt. well for their future healthcare. What I would recommend is paliative care only for those who have ruined their own lives. I don't know which is the more malevolent towards humanity, Left-wing Health Nannies or Right-wing Health Nazis.
Dave has got to bring back foxhunting and hare coursing. The Right can then sublimate their desire to cause hurt by pursuing these pastimes, and the Left can sublimate theirs by pursuing the blood sportsmen.

[grumpy old man]

chegtui, you are at your best when you resist the urge to descend into gratuitous abuse, however strong the temptation. Having a brain, you know perfectly well that the traditional marxist/socialist method of attempting to solve a problem, by throwing other peoples money at it in the hope that some of it sticks, is foolishness in the extreme. Remember, Coherency is not a Socialist Core Value, so they cannot argue, "issues", only deliver polemics and personal abuse. Try to avoid the trap, there's a good fellow.

[Malcolm Stevas]

snegchui rants:
"Go mate with a shrew and good luck may it do both of you."
This cod-Ruritanian insult is so colourful, so surreal, that I felt compelled to quote it first, rather than your strangely skewed argument - such as it is. When you say, "Prevention is better than the cure is a very good conservative principle...You seem to wish to deprive people of facts." your two key fallacies are summed up. One, you believe "prevention" is necessarily a job for the State - perhaps because you think the State owns us, or we are too infantile & incompetent to look after our own health? - and two, which somewhat contradicts your other position, you believe that if everyone is simply provided with "the facts" by the State (assuming optimistically that the State is willing and competent to do that) then they will act rationally to safeguard their bodies! I get the impression you are one of many so-called "conservatives" who have been brainwashed by decades of Statist propaganda into believing that to express faith in people's ability to organise their own healthcare, and actually take responsibility for themselves (as an alternative to a monolithic, cumbersome, inefficient NHS) makes one a "Health Nazi"... Thanks again for the shrew thing, which brightened my day.

[Treacle]

I don't anyone funding my medical care, and I don't want to fund yours.

We have crap, centralised, inefficient, lousy nationalised state health care. In every other walk of life the state run option has been rejected but we go on propping up this monolithic basket case with its filthy hospitals.

Idiots like Lansley then think they have the right to say 'because we force you to pay and it doesn't work we will ration your health care'

Give me my money back and sell off the hospital service to Bupa etc

I want my money back and Lansley on the scrap heap

[passing leftie]

We have crap, centralised, inefficient, lousy nationalised state health care. In every other walk of life the state run option has been rejected but we go on propping up this monolithic basket case with its filthy hospitals.

It's not inefficient, it's not crap and it's not lousy. It offends your right wing ideology to think otherwise, but some things are best done by the state, some by the private, some by the third, and some by a mixture.

After massive increases in expenditure, we've nearly caught up with the rest of the developed world in terms of % GDP.

You'll pleased to be reminded that dear Andy also gave a brilliant unfunded spending commitment back in February:

"A Conservative administration would increase health spending by up to an extra £28 billion a year, a leading moderniser has told The Times. Andrew Lansley, the Shadow Health Secretary, gave a long-term commitment that under the Tories health spending will rise to take up an extra 2 per cent of GDP."

So, no free treatment for the morally suspect and extra money coming from out of his orifice for everyone else.

The NHS could need to set up a special "Moral Judgement" unit to examine potenital patients before they get treated. Those who had health problems caused by their own actions would be thrown out on the street (if poor) or made to pay for treatment (if rich).

[snegchui]

I will reiterate prevention is better than a cure, usually cheaper as well. Perhaps a medical professional could comment on why checkups etc seem to be difficult to get on the NHS, ie why does it seem to insist on being more reactive than proactive.
On public education, it will always be a question of numbers. You will never get 100% agreement on anything. I do find it odd that making information readily and easily available should be so resisted. One argument might be that communications depts seem so often to spend so much money for so little return. However I can see nothing wrong in having a subject up to school-leaving called Lifeskills which would cover nutrition, health, finances, civic society (lovely and vague but to me covering how institutions work and interact) and I think such a course would be better than some currently on offer. Yes, you will have failures, but keeping failures to a minimum is better than throwing hands up in horror at the irrational and uneducated of the turkey-swizzling couch-potatoes persuasion who lack the stamina to work beyond 30 and satrt taking Blood-Pressure medication and diabetes medication 2-3 decades before they should be necessary. The world has changed, not least in its affluence, which allows lifestyles people only 50 years ago considered unimaginably wealthy. It brings new problems and to ignore them does us no favours.
However witholding treatment after having taken the money is not ethical, whether public or private. The NHS no exists in a world where medical advances are a victim of their own success, and a major discussion is needed on limits. Rationing is already taking place and people don't like it, but it is taking place in an environment where it is not supposed to exist and therefore not fully acknowledged. This does no favours in advancing the discussion of whether to reform or move to a different system.
Suppressing information or its dissemination is usually the act of authoritarian or socialist states and I look with deep suspicion at people who seek to dam the flow of information.

[Ben]

What are you all talking about? This is a policy which is already universal in both private and public health services. If you are unprepared to stop the thing that caused your disease or likely to render the treatment you are being given a doctor will not let you have it! This isn't ground breaking new stuff amongst health care professionals!

[Treacle]

I have had close friends killed by your disease filled hospitals passing lefty, so forgive me if I put my health and that of my family before the propping up of your failed socialist experiment.

Old people dying of clostridium difficile in their hundreds whilst lying in their own filth... shameful

[Treacle]

I have had close friends killed by your disease filled hospitals passing lefty, so forgive me if I put my health and that of my family before the propping up of your failed socialist experiment.

Old people dying of clostridium difficile in their hundreds whilst lying in their own filth... shameful

[Malcolm Stevas]

snegchui writes:
”I will reiterate prevention is better than a cure..”
Everyone knows this: no-one’s arguing with you. But it’s not (or shouldn’t be) for the State to take it upon itself to prevent people from harming themselves, through bullying and propaganda. There is so much information available that there is no excuse for anyone to be ignorant about cause and effect re food, drink, exercise etc – those who proceed wilfully to harm themselves despite this should be free to do so, and accept the consequences of their actions. Naturally, I don’t expect the rest of us to pick up the bill for this, because I don’t think the State should be involved in healthcare – or much else.

”I do find it odd that making information readily and easily available should be so resisted.”
Who’s resisting? See above: the “information society” is more than a catchphrase, it aptly describes the modern world. Food is already labelled so exhaustively it’s in danger of defeating its own object, by making it difficult to read all the stuff on the labels…

”I can see nothing wrong in having a subject up to school-leaving called Lifeskills which would cover nutrition, health, finances, civic society…”
They already do this stuff in schools and FE colleges, and have done for years! Most kids regard it as extremely boring. It is in any case the duty of parents – I want my child to receive academic instruction at school, not “Lifeskills” crap dreamed up by some nannyist prat at the DfES.

”The world has changed, not least in its affluence, which allows lifestyles people only 50 years ago considered unimaginably wealthy. It brings new problems…”
You’re stating the obvious again. The affluent always had the opportunity to eat and drink to excess, in the past as now, but only the foolish and feckless did this. Rational people don’t lie on sofas stuffing themselves with snacks then expect the rest of us to fix their health problems. If you want to regard such people as victims, you are free to subsidise their healthcare, but don’t expect everyone else to.

”Suppressing information or its dissemination is usually the act of authoritarian or socialist states and I look with deep suspicion at people who seek to dam the flow of information.”
Me too! Many of them are called politicians, and they often don’t so much suppress information, as distort it for their own ends. They often seek to increase their power by increasing citizens’ dependence on them and the gifts they dispense, such as healthcare for people who have wilfully damaged their own health, which is paid for largely by people who haven’t done so… As for information in general, see above. There’s an awful lot of it out there for anyone who cares to look.

[passing leftie]

I have had close friends killed by your disease filled hospitals passing lefty, so forgive me if I put my health and that of my family before the propping up of your failed socialist experiment.

Posted by: Treacle | September 11, 2008 at 14:59

I'm sorry to here that, and I'm not surprised you don't like the NHS. Understandablt, Anecdotes of events which cause personal grief usually outweigh evidence.

Satisfaction with direct experience with the NHS remains extremely high compared with other countries, and a large majority prefere a state funded system. They even prefer the same provision in each region and not having local variations.

[snegchui]

The information society may be out and about, but there are problems with it. One of these problems is finding unbiased, carefully-reasoned sources. Studies on the harmless effects of cigarettes funded by the Tobacco Companies spring to mind, some of the more extreme fundamentalists of all religions spring to mind. The role of the state here is to try and provide that source. Cue roars of rage about the BBC. All I can say is that where I grew up, BBC World Service was a lifeline and a beacon of knowledge. I started blogging on CH because of BBC photo-coverage of David Cameron about this time last year when General Election fever was in the air. Constant vigilance is all I can say.
But in imparting information, there is the message and the medium. And if the medium doesn't engage, as it doesn't in so many State Communications, (why are they paid so much???)then the medium needs to be more examined more closely. I will accept if it proves difficult to bed in the basics of reading and writing, then learning other things is going to be difficult or non-existent. And the choices made on such a limited base are not likely to be rational at all.
The approach is this: You can yell shout and scream at new army recruits to bull and shine and wallop them if they don't. The moment they are out of your influence, backsliding and minging quarters, field and barrack.
Or you can explain why bull and shine is necessary and why it is their best interests to be very aware of their immediate environment and why if you place things in an orderly manner, if you have to leave hastily in the dark you know where to find things and you don't trip over them. Much less backsliding and anti-social mingingness in the neighbourhood.