On a radio discussion show shortly before the general election I made the not terribly original point that the NHS had become our national religion. The first caller immediately objected. ‘No, it’s not,’ he said. ‘The NHS is far more important than a religion — it’s about life and death.’
Ignoring the theological presumption for a moment, this view is common enough. Even when not ‘in crisis’, the NHS is now perennially said to be ‘under pressure’ and so becomes an ever-larger part of what government does and the public expects. George Osborne refuses to seek savings in its budget and promised an unbudgeted further £9 billion during this Parliament. And as the NHS becomes the dominant and only untouchable force in the state, so its enemies (the eaters, the drinkers, the old, the infirm) become enemies of that state. This was always one of the perils of a socialised medical system. And today it is not just the government’s problem. Increasingly we are all expected to put our shoulders to the task of assisting the great effort of permanent NHS rescue.
If you doubt that, consider the limitless amount of sermonising we are willing to put up with when it comes from the NHS. What used to be matters for the church, family or what we used to call ‘free will’ are now cast in the language of the NHS as matters that affect us all.
Ordinarily, if you told a member of the public when they should procreate, what else they might or might not put into their bodies and what body-type was ideal, you would be invited to go and procreate yourself. But when it comes from the NHS and is expressed as being for the good of the nation, then even the most intimate details of your life can be transformed. The last week had some especially fertile examples.
Professor Geeta Nargund, one of the NHS’s top gynaecology consultants, wrote to Nicky Morgan warning that women who start trying to become pregnant after the age of 30 risk never having children. The reason that the Education Secretary was the recipient of the letter was because Professor Nargund was demanding that teenagers in schools be taught the dangers of having children too late. You certainly can’t envy the teachers. In between teaching citizenship, national identity and the English language, they must now impart the precise moment when girls should make babies. Not as a teenager, of course (the NHS is still trying to bring that figure down) but not as a withered 30-year-old either. Perhaps for the next lesson the NHS could give teachers information packs on how to meet the right man, start a promising career and earn enough money to put down a deposit on a flat between the precise ages of 18 and 30?
Professor Nargund’s request will be welcomed rather than objected to because she has the new golden argument behind her. The problem must be tackled, she explained, because of the spiralling costs to the NHS of IVF treatment for women who have left ‘trying for a baby’ to their thirties and forties. What might have seemed intrusive or nannyish suddenly becomes publicly vital.
Every other conceivable problem is increasingly expressed in the same way. Last weekend the chief executive of NHS England, Simon Stevens, focused on obesity. ‘We have got to get much more serious… about our own health and about prevention,’ he warned us via the BBC. If this came from a minister it would be deemed hectoring. But from an NHS chief executive it is easier to swallow. Stevens wisely gave us a spoonful of sugar to help the medicine go down: ‘We’ve done actually very well in terms of cutting smoking and teenage pregnancy and drink driving.’ Yet there is a new problem, as there always is. ‘The new smoking is obesity. It’s going to take all of us to play our part.’
If that is the case then the crisp-munchers should watch out. Because until now smokers were the easiest targets in the NHS’s sights. Never mind the fact that most smokers put in far more money in taxes on cigarettes than they take out in cancer care, they provided a sitting target which no metastasising bureaucracy could resist. And once the culprit is identified, absolutely anything can be done in the name of ‘prevention’. So the anti-smoking movement, which first criminalised smoking in public places, then seamlessly did what it said it never would and criminalised it in private places too. Costs to the NHS were the driving excuse. Last week in Hull a two-year-old boy was taken away from his parents after a health visitor expressed concerns about the ‘smoky house’ in which he was growing up. The judge who considered the case ruled that, ‘Adoption really is the only option now available to (the little boy), in my view. Nothing else will do.’ There was consolation, though, as the judge said, ‘I want him to know that in my judgment his parents loved him very much and tried very hard, but they were simply not able to meet his needs.’ Doubtless that will comfort him one day when he reads through the court judgment in his foster home.
Now that obesity is the new smoking, can we look forward to fat parents having their children taken away as well? After all, if the parents failed to follow NHS guidance on diet and exercise then it’s not just that they are making their own flawed choices and decisions — they are a drain on the public finances. Chief Executive Stevens has already warned that, ‘We’ve got the biggest use of fizzy sugary drinks of any country in Europe’ and said that producers and retailers risk ‘poisoning’ people, with long-term costs to us all.
The problem with all this neologism and talk of epidemics is that only one entity benefits and grows its power — the organisation of which our government increasingly becomes simply the political wing. In 2001, the NHS absorbed a quarter of government departmental spending. Under David Cameron this will rise to more than a third. In this set-up the organisation’s potential for setting unreachable targets could be endless. Consider the NHS’s advice on drinking. A poll carried out last year by the World Health Organisation placed Britons among the worst binge drinkers in the world. But consider what now constitutes a ‘binge’. The NHS’s own definition includes ‘drinking to feel the effects of alcohol’ and includes as little as two glasses of wine. It is all very well to laugh, but really you should consider the long-term costs to the NHS of people who drink half a bottle of wine once a month.
NHS chiefs are proud of saying that one in three children born in an NHS hospital today is likely to live to 100, but good luck to them if they try. The final intrusion into their lives will come if they are not still a fully productive member of the economy in their nineties. Then the heirs of Lord Falconer and Baroness Warnock will explain that they are not just wasting their family’s time but — in Warnock’s words — ‘the resources of the NHS’. Already you hear it mentioned in government that an 80-year-old costs the NHS seven times as much as a 30-year-old. The Institute for Fiscal Studies did the sums earlier this year and it’s not hard to see how the idea will grow that older people — by staying around — become burdens and eventually enemies of the state.
It’ll be a fine balancing act for generation 100, that’s for sure. But they will have volunteered for it. In the same way that massive intrusion into our online lives came not from ‘big brother’ but from our own desire to share the minutiae of our lives with the world, so the great intrusion into what we do with our bodies came not just through some top-down diktat but from a rising and generalised agreement about the most efficacious use of the public coffers. An opt-in health insurance system allows you to take whatever risks you are willing to pay for with your own body, whereas the NHS gives everybody an interest in everybody else’s body. And without strong ethical or moral guidance from any other source this rampant utilitarianism becomes the dominant ethic in the land. It does seem to have some idea of a life well lived: a non-smoking, non-drinking fitness fanatic who starts a family in their most productive years and has the decency to die at just the moment when they risk taking out more money than they have put in.
It will keep the NHS in perpetual business, of course. And it may be that one day we will be able to produce a comprehensive budget breakdown for how to live the new ideal life. But this new more-than religion still leaves one noticeably gaping question: what is it all for?