The Sunday Telegraph - Sunday
The NHS doesn’t want us to be healthy. It just wants us to be cheap
Oh dear, it’s NHS fat-blaming time again. Data dusted up as shiny and new – like food moved around on a plate – was presented at a conference last week. The take-home? To show just how much the pesky population costs its national health service.
Obese people were ranked from very obese (BMI of more than 40) to just obese (BMI 30-35) in terms of how expensive they are to the health service. Using the health records of 2.4 million adults in north-west London, the researchers found that the very fattest cost the NHS £1,375 a year on average while the plain obese only cost £1,178. Those of “a healthy weight” cost the health service a mere £638. Gold star for them.
There would be something funny in the trifling bizarreness of such information – being obese rather than morbidly obese “saves” £197 per year – if it wasn’t so sinister.
Not because excess weight isn’t a real issue – we know very well that it is, both where physical and mental health are concerned. Indeed, the very fat are also more likely to have low self-confidence and suffer from depression.
But the study, presented at the European Congress of Obesity in Dublin, is disturbing because it suggests how ingrained is the attitude that we must all live our lives purely in consideration of the NHS. Our lives increasingly appear to be evaluated chiefly in terms of whether they are convenient or costly for our beloved health service.
Rather than radically overhaul the NHS, of course, policymakers instead prefer to foist responsibility for the teetering service’s vulnerability on us. Instead of being its fault for wasting resources and courting inefficiency, it’s our fault – we eat too many pies, we don’t do enough daily steps, we drink too many beers.
The totemic standing of what was once the glory of the welfare state, as well as political terror at seriously rethinking the way the NHS is funded, have led to all sorts of illiberal policy decisions. The sugary drinks tax, introduced in April 2018, was one such example, and beyond reminding us all of the long arm of the state, few would claim that it has done anything much to slim the nation’s waistlines.
This seemed to set a precedent for top-down meddling in the minutiae of our daily lives, so often justified as necessary to prop up the NHS.
In 2020, the anti-obesity bit between his teeth, Boris Johnson was all set to interfere with the operation of private enterprise – and freedom of speech – by banning adverts for high-fat, sweet or salty foods before the 9pm watershed. It’s to Rishi Sunak’s credit that he has shelved these measures – at least for now.
The disturbing idea that we serve the NHS – not the other way round – was also visible during the recent mass walkouts by nurses, junior doctors and ambulance workers.
People were advised by health service bosses not to do anything “risky” during the strikes lest they might require medical assistance. They might not get the help they need, they were told, and worse, they’d be – you guessed it – burdening an NHS that was operating, once again, under adverse conditions (this time of its own making).
And who can forget the tragedy of all the people who died of strokes and heart attacks during the pandemic because they were afraid to trouble our doctors and nurses? This fitted the pattern of months of lockdowns during which we were less told to protect ourselves than to “protect the NHS”.
It’s very likely that lockdowns would still have been chosen for the sake of public health – Israel, Germany and France went all-in, despite having much better health services than us. But to tell us to make enormous sacrifices in order to save an NHS that is supposed to be there to save us was just manipulative.
The Government’s own press releases, such as one from last November, contain headlines bragging about how new measures to tackle obesity will “save the NHS billions”. I have noticed little such bragging, of course, about how much better patients’ lives would be if they lost weight.
The two bullet points on the release are: “Obesity costs the NHS £6billion annually, a figure which is expected to rise to over £9.7billion each year by 2050” and “Funding will fast-track treatments, enabling the NHS to reallocate the money to vital front line services”.
This is just deranged. Any health service in a civilised nation should have “vital front-line services” long nailed down and be able to prove its worth in many other areas. That it has become normal Government messaging to make people feel like they’re the problem – that they’re making the wrong consumer (or other) choices for the public good –
Responsibility for the service’s vulnerability is foisted on us – we eat too many pies
shows how far we are down the blind alley of NHS religiosity. But the “serve the health service” message appears to be the logic of the system now, and will stay that way, and inevitably get worse, as the NHS gets more dysfunctional.
Fiddling is a classic sign that Rome – or Britain – is burning. The fixation with obesity not for the sake of people’s health but for the NHS’s has unleashed a tsunami of state micromanaging.
We are meant to be shocked at how much obese people cost the NHS. But in a society with a well-functioning – universalaccess but insurance-led – health service, £1,378 per person would be seen as trivial, and individuals’ food choices very much their own business.