Keep taking the medicine

November 28, 2012 by
Filed under: Public policy 

I am just off to the Moral Maze to take a position on whether, in some cases, NHS treatment should be conditional on people changing their life style. ‘Ah, but which position will you take?’ I hear my reader say.

I am against the two women respectively from the BMA and Patient Concern and on the side of the two men from the Institute of Economic Affairs and the National Obesity Forum; yes the NHS should in some cases make treatment conditional on patients offering their own contribution to getting healthier. Although one of the joys of Moral Maze is that one rarely ends up in exactly the same position that one starts, my position starts from three grounds:

The principle of conditionality applies in many other areas of welfare – why should health be an exception?

Public sector austerity means that rationing is inevitable. Isn’t it both appropriate and just that one criterion is the willingness of those patients who are able to work with the health service to achieve a successful outcome do so.

It is more progressive to see public services not as things that are delivered but as reciprocal relationships. But you won’t develop grown up relationships if there is ultimately no sanction for either party if they abuse that relationship. Just as patients should have rights of redress for poor treatment and care so health professionals should have some scope, within clear parameters, to make professional judgements about whether a patient’s behaviour makes treatment more or less likely to succeed, and on that basis they whether they should be apriority for health care.

I can immediately see many of the objections to this argument (inequality in income and other personal assets providing the basis for many) but I won’t rehearse them as they will no doubt be very well made by guests and panellists on the programme (it’s on Radio 4 at 8pm).

The key point I want to try to get across is that the case for conditionality is not one which has to imply intolerance or hostility to strong public services. Indeed the reverse, it can also reflect a deeper ambition for public services – not just helping people with problems but enabling them to be better able to meet their own needs.

Mind you, having said all this I will probably be distracted as my thoughts keep drifting to how the amazing West Bromwich Albion team is doing at Swansea City. And if we win and in celebration I pull a muscle punching the air I will feel my GP is totally justified in telling me to buy some aspirin and learn to be more sensible next time.



  • Jules Evans

    You’re on with Philip Lee? Am interested in his idea of returning to a ‘more Stoic Britain’. If you were feeling kind, you could mention that Exeter University is running a ‘Live Like a Stoic’ week at the moment, in a project involving philosophers, psychologists, and ordinary people learning how to practice Stoicism in everyday life.

  • Bernard Mason

    I hope that the question of what to do about intractable behaviors which negate the effect of treatment will be addressed

  • Robert Burns


    paragraph 5 highlights an endemic problem in practically every area of the public domain.

    Legitimacy rests on entering into and performing mutually binding obligations.

    So, with appropriate safeguards, conditionality in respect of NHS funded treatment is entirely reasonable.

    Taking a sideways step here government could do themselves some good with the electorate if they applied this principle to businesses who contract with local and central government.

    What do I mean?

    It should certainly be a standard condition of any contract with local and central government departments and agencies that the contracting business demonstrates that they are actively recruiting from the registered unemployed?

    Afterall, if the business expects to be paid from funds held by the electorates’ government, then the business should be required to demonstrate that they have a ‘members of the electorate first’ recruitment policy.

    Similar policies are currently in place in respect of ‘green’ issues, equal opportunities, etc. then why not the registered unemployed?

    This would cut several ways – all of them likely to be very popular with the public – as follows:

    (a) It would show that when the government spends taxpayers’ money with private businesses within UK borders it makes a priority of employing UK residents (regardless of race, age, gender or ethnic origin) who are members of the electorate;

    This should be a policy that stands outside party politics.

    (b) It would help cut the state benefits bill;

    (c) It would be a powerful tool in flushing out ‘professional claimants';

    (d) It would go a long way to achieving more than what the present governments’ ‘Work Programme’ has spent £5.5 Billion failing to achieve

    If the political class are serious about engaging the electorate and turning around their bad brand image they could start here.

    A possible topic for debate another time?

  • Bernard Mason


    Because of your post, I listened for the first time for months.

    I really do feel that you should consider whether this program is worthy of your time.

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