Thursday, 29 November 2012

Doughnuts for breakfast?

Recently I heard an interview with, or about, Dr Phillip Lee MP on the radio as I was driving to work and it made my ears prick.  It was a fascinating debate with strong arguments on both sides.  In essence was about Dr Phillip Lee MP suggesting that fat people, who decide to "......have doughnuts for breakfast" should be paying for their own healthcare further down the line.

Dr Phillip Lee MP

This whole story arose from the news of Dr Phillip Lee MP being involved in a debate about the sustainability of public spending.  He made reference to the fact that we currently spend approx £320bn pa on health and welfare in Britain, which has more than doubled in the last 10 years.  The direction of spending in these two areas is clearly not sustainable, particularly in view of the fact there is a large cohort of baby-boomers about to enter their 70's. 

So it is all very well agreeing we need to make cuts so the Government is able to pay it's credit card bill but it's not so easy to suggest where those cuts should fall - this is a potential minefield for any politician as they're simply bound to upset someone.  You can easily imagine letters from "Disgusted of Tunbridge Wells" arriving by the sack load.

What is interesting is Dr Lee is still a practising General Practitioner (part time) and that, I believe, gives him a certain right to make real contributions for these debates.  He's not [then] basing his comments on anecdotal information or spin but instead on real life observations.  Having had further reliable information from his office, the great majority of prescriptions he signs are for conditions directly linked to the lifestyles of his patients.  These conditions include, for example, type 2 diabetes and everything that goes along with it.  Naturally we should bear in mind, a relatively small number of patients can develop type 2 diabetes through no fault of their own and that is where an important distinction could be made.

My own take on this....

In other words, people who develop healthcare problems such as obesity, type 2 diabetes are actually a ticking time bomb for themselves and the country.  Why should the NHS pay huge sums of money to treat and care for people who have needlessly brought about illnesses for themselves?  This argument could, one supposes, be extended to include those who smoke or drink too much alcohol (and how much alcohol is "too much alcohol" is another debate).  Then there are certain spin-offs where the NHS withholds treatments until the patient has made certain lifestyle changes themselves.  Examples of this would include losing some weight before knee or hip operations or maybe gastric band operations.

Party politics and the whole question of Government spending aside, you could say Dr Phillip Lee MP is doing a good job by stirring some debate and controversy in an appropriate manner for an MP.  He's certainly got the best interests of his constituents at heart.  Good for him you might say, especially as he's speaking with some authority on these matters.  And yet there are counter arguments of this proposal is now suddenly going against the whole ethos of the NHS which is an institution we should feel proud of and which is admired throughout the world.  One of the main values is about there being free health care at the point of need.

On that last point I would say that this principle has been sliding for some time with differences in NHS dentistry and what is commonly available in private High Street dental practices, not to mention opticians and their services which easily go beyond those basic NHS packages.  For decades we have had to pay for our prescriptions; currently the £7 or £8 is only a token payment towards the whole-system cost of issuing the prescriptions.

It is fair to question why the NHS should continue to look after people who won't look after themselves; in these days of austerity all public expenditure must be questioned right from the cost of the Prime Minister's salary through to the cost of emptying our rubbish bin every week.

For NHS patients, surely there is a difference between won't and can't look after themselves?

I remember a while back visiting a hospital and seeing a couple of patients sitting in wheel chairs outside the main entrance.  Both were in their nightwear and were wearing dressing gowns to keep warm as it was a bitterly cold day.  One was connected to some kind of drip and were chatting sociably with each other.  The striking thing, however, was that they were both smoking cigarettes.  That, I thought was quite a provocative thing to see by anyone in such a public place.

And yet, should those patients then be invoiced for the cost of their treatment (if it was connected to their smoking)?.  Very tricky.

For Dr Lee, I would suggest a couple of things here.   It is not easy trying to change people's behaviour without firstly changing the way people think and about their own attitudes towards life.  Investing money in public health is an investment for the future.  It is commendable that we have programmes to assist people to make positive changes in their lifestyle such as Stoptober but they need to be more effective and far reaching.  The same applies to diets and alcohol and drug use - investing in prevention will pay dividends for generations to come.  I reflect on my own history as an ex-smoker and someone who, on reaching my 40s started to gain that extra weight and living with too much stress, saw the light and made a choice to do something about it (see my About  page).

All very well but how could this be paid for?  A fair question indeed.  My immediate thought is this is so complex but how about through even steeper taxation on cigarettes and alcohol? So what if a packet of 20 cigarettes already costs £7 or £8 - make it £27 or £28 through increased taxation!  It might not be a vote winner but it is in the best interests of the country as a whole, as well as individuals.

Well done Dr Lee for re-igniting this topic!  Thank you also for reading my own views on this matter.  Have I gone too far, perhaps too radical?

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