An unpleasant mentality is distorting the notion that the NHS is a national health service. Increasingly, politicians, the media and medics are taking the line that treatment can be legitimately withheld from people wicked enough to disobey the official disapproval of smoking, drinking, getting fat and so forth. For example, Norfolk Primary Care Trust has decided that confirmed smokers are to be taken off waiting lists for “all non-urgent operations such as hip replacements ….[because] Smokers have three times the complications as non-smokers”. (Metro 23 10 2006) I think anyone needing a hip replacement would dispute the operation’s definition as non-urgent. It is worth adding that the story mentions the Trust is “£50 million in the red” and an unkind soul might conclude that the withdrawal of treatment to smokers is connected to the debt. Nonetheless, the fact that smokers have been targeted speaks volumes for the ideologically driven mentality within the present day NHS. It is only activities which come within the ambit of official disapproval and moralising that are the subject of such withdrawal of treatment – it is noticeable that no politician or health trust has suggested that treatment for AIDs or HIV should be withheld because it is in most instances the consequence of the individual’s behaviour.
The moralising which bolsters the supposed clinical case for withdrawing treatment from certain groups runs along the lines that people are being selfish and irresponsible by smoking, drinking, getting fat etc. Wild claims are made for deaths supposedly due to such behaviour – any smoker who dies at a ripe old age is as likely as not to be classified as dying from a smoking related disease. All this supposedly self-inflicted illness is portrayed as being a massive burden on society and especially on the NHS.
Most absurdly and dishonestly, smokers are claimed to be a drain on the taxpayer despite the fact that tobacco taxes (excise duty and VAT) greatly exceed any additional costs smokers might place on the NHS. Ditto with alcohol and alcohol related illness.
But do smokers, drinkers and the fat, who on average die younger than those who do not display such traits, actually impose extra costs on the taxpayer? Writing in the Sunday Telegraph (22 1 2006) the historian Niall Ferguson baldly and erroneously claimed those who smoked, drank and got fat are being antisocial because they “tend to expire slowly and expensively”. Most do not and whatever cost to the taxpayer arises from such people it pales into insignificance compared with those who live to a ripe old age. Not only do the latter draw pensions and benefits for far longer than the shorter lived smokers, drinkers and the fat, but the most costly of NHS patients are those who live to extreme old age for they frequently end up in hospitals or nursing homes for months and years. The most antisocial thing a person can do from the taxpayers’ point of view is live to an extreme old age.