Elmbridge councillor defends two-tier NHS proposal
Those who drink, smoke, take drugs or are obese should be told to shape up, ship out of Surrey or endure a slower healthcare service.
That is the message in an email, leaked to the Elmbridge Guardian, from a Conservative councillor who sits on Surrey’s health committee.
Cobham councillor John Butcher, elected in Surrey and Elmbridge, said offering a slower-moving waiting list for the “self-inflicted” would force them out of Surrey to areas where politicians believe in equality in the NHS.
As a result, these equality areas would see voters die out at a faster rate and lessen the power of those that represent them in Parliament, the email continues.
Coun Butcher said: “If the NHS in Surrey were to be run on the basis that patients with self-inflicted morbidity (mainly smoking, alcohol, narcotics, obesity) and injury (dangerous activities) are, following due warning, placed in a much slower-moving queue for healthcare than ‘other’ patients, this would encourage the self-inflicted to move away from Surrey, to areas where there is no differentiation between patients on the grounds of their contribution towards their condition.
“And it would deter the self-inflicted from coming to live in Surrey. “Over time, that would result in the healthcare for the ‘other’ patients in Surrey being significantly better than the average national level for all patients, as the resources deployed to the self-inflicted would be very much reduced.
“This factor would attract more ‘other’ patients to come to live in Surrey – and that would push up house prices here.”
The comments were made in an email to a council employee to explain his absence from the health overview and scrutiny committee (HOSC) on May 24.
The email spread like wildfire through the council and was eventually forwarded to this newspaper by an anonymous source.
Residents’ Association councillor Karen Randolph, chairman of the Save Our Surrey Community Hospitals campaign, said: “The views expressed by Coun Butcher challenge the very credibility of Surrey County Council’s (SCC) HOSC.
“It is highly disturbing the Conservative administration at SCC has deemed it appropriate to appoint to this committee a councillor who clearly does not support the NHS and who holds such extraordinary views about the responsibilities of the state to its citizens.”
Brian Mackenzie, a volunteer in the drug and alcohol sector in Surrey, said addiction to drugs caused misery, pain and death. He said: “It is a disaster and we try to help these people get back on their feet, rather than export them to a desert island, like we used to do with prisoners to Australia to get them out of the way.
“We want to be positive about it and try to get treatment for them.
“This man has no idea and he should probably inform himself by working as a volunteer in one of the agencies that help people with addictions and learn about the issues before he opens his mouth.
“I thought it was a joke at first, some sort of satire. It is unbelievable. But, thankfully he is in the minority and this is not an establishment view.”
Coun Butcher said the email was based on a submission he made more than two years ago about the NHS constitution, where he suggested the risk of worse healthcare for those with harmful habits would hopefully be enough to encourage them to lead healthier lives.
He said: “This country needs an honest debate on how the NHS can be saved and many patients must be encouraged to do a great deal more to reduce the self-inflicted demands they make on the NHS, to help it survive, and to help themselves and other patients, who suffer when resources are diverted into dealing with such self-inflicted demands.”
In response to Brian Mackenzie, Coun Butcher said: “I need to make it clear that, under my proposals, a condition would not be regarded as self-inflicted if the patient was unable to prevent the condition, as is the case with an addict, even if he or she was able to have done that before addiction set in. But I would expect an addicted patient to seek prompt help and to co-operate with NHS and related efforts to help him or her overcome that addiction.”
Councillor Butcher's email in full:
1 Please pass on my apology for absence from the Surrey HOSC meeting on 24 May 2012, but I have a hospital appointment that day, and it has already been postponed once.
2 Because of the economic catastrophe facing the capitalist world, the NHS, that is a Marxist organisation, is bound to fail - like Greece.
The government’s efforts to ‘improve’ it are merely a postponement of that failure, which will arise from ever-increasing demand for, and the unit costs of, healthcare and the ever-decreasing national wealth available to afford those demands and costs, through taxation or otherwise.
Politicians who support the diversion of increasingly scarce fiscal resources into propping up the NHS, without taking measures to curb demand, not only accelerate its eventual demise but allow more important demands on the public purse to go unmet, with serious adverse consequences to the people. It will be the people who suffer from the collapse of the NHS – but they will have only themselves to blame - for voting in politicians who promise to improve the NHS regardless of other factors.
3 One way of saving the NHS is to encourage patients to take very much more care of themselves, with penalties on those who won’t do that. If the NHS in Surrey were to be run on the basis that patients with self-inflicted morbidity (mainly - smoking, alcohol, narcotics, obesity) and injury (dangerous activities) are, following due warning, placed in a much slower-moving queue for healthcare than ‘other’ patients, this would encourage the self-inflicted to move away from Surrey, to areas where there is no differentiation between patients on the grounds of their contribution towards their condition.
And it would deter the self-inflicted from coming to live in Surrey. Over time, that would result in the healthcare for the ‘other’ patients in Surrey being significantly better than the average national level for all patients, as the resources deployed to the self-inflicted would be very much reduced.
This factor would attract more ‘other’ patients to come to live in Surrey – and that would push up house prices here – assuming that planning controls remain similar to now.
4 Eventually the self-inflicted patients would end up living in ‘equality’ areas that are dominated by politicians who pander to their needs, thus driving more ‘other’ patients out of those areas, as healthcare there will be badly affected by the over-dominance of the self-inflicted.
These ‘other’ patients would move into areas, such as, hopefully, Surrey, where ‘other’ patients are not nearly so adversely affected. Eventually the country will be sharply divided into two types of area:
4.1 the ‘equality’ ones, where the self-inflicted unhealthy are treated the same as all patients, and 4.2 the ‘others’, such as, hopefully, Surrey.
Average life expectancy will be substantially lower (by, say, 20 years) in the ‘equality’ areas than in the ‘others’. This may mean that ‘other’ patients moving out of ‘equality’ areas may have to live in a less desirable dwelling, because of house price differentials, but that is a trade-off, that they can choose, with healthcare differentials between the two types of area.
Such house price differentials already apply for schooling, with houses on one side of a catchment boundary being worth a lot more than houses on the other side of it.
Indeed, the perception that the gap in those prices between those two types of healthcare area will grow substantially will encourage the ‘other’ patients in those ‘equality’ areas to move out of them sooner, lest they see their dwelling there becoming worthless.
5 Thus, any political party that seeks to pander to the needs of the self-inflicted unhealthy, and to win their votes, will suffer twofold: 5.1 mortality will ensure that its voters will be much fewer in number than the ‘others’, and
5.2 by concentrating its voters into particular areas, that party will never be able to win enough seats to dominate Parliament.
Regards John Butcher
Councillor Butcher's response to the Elmbridge Guardian:
This country needs an honest debate on how the NHS can be saved; and many patients must be encouraged to do a great deal more to reduce the self-inflicted demands that they make on the NHS, to help it survive, and to help themselves and other patients, who suffer when resources are diverted into dealing with such self-inflicted demands.
The e-mail that I sent to members of the Surrey Health Overview and Scrutiny Committee is based on a submission that I made over two years ago regarding the NHS ‘Constitution’.
In that submission I suggested that the risk of suffering worse healthcare, if the patients with self-inflicted morbidity etc. do not change their harmful habits, would, hopefully, result in the great majority of them making that change, thus enabling them to live longer, and to reduce the resource burden on the NHS. I readily accept that some of those patients would not make the needed change, but would expect that, overall, there would be a net benefit to the health and longevity of those patients – and a net benefit to other patients, as a result. This is not the line taken in my message to colleagues, as I wanted to show in that message what would happen if those patients do not respond in this way, in order to illustrate how different parts of the county might experience different outcomes.
This approach is already happening. Liver transplants are limited for alcoholics. For clinical reasons, some NHS areas require obese patients to reduce their weight substantially before they undergo major surgery.
Today, Ian Duncan-Smith, the Secretary of State for Work and Pensions, is due to issue a statement that social security benefits will be withdrawn from alcoholics and drug addicts if they refuse to accept treatment – an approach that is consistent with what I advocate.
With private medical insurance and medical cover abroad under travel insurance, there are a range of measures that differentiate patient cover along the lines that I am advocating for the NHS.
The ‘culture’ of the NHS may well be unreceptive to the approach I advocate – but that is largely due to it having never properly contemplated the need for drastic ‘surgery’ to ensure its own survival. I appreciate that clinicians will not want to have the added burden of deciding whether or not a patient with a self-inflicted condition ought to be ‘slow-tracked’. How to deal with that was addressed in my earlier submission.
Councillor Butcher's response to criticisms
In response to Brian Mackenzie, I need to make it clear that, under my proposals, a condition would not be regarded as ‘self-inflicted’ if the patient is unable to prevent the condition, as is the case with an addict, even if he or she was able to have done that before addiction set in.
But I would expect an addicted patient to seek prompt help and to cooperate properly with NHS and related efforts to help him or her overcome that addiction - along the lines of the IDS approach that I mentioned to you. I admire the work done to help addicts and that must be fully supported. Indeed, I would expect that my suggestion should result in fewer individuals becoming addicted and more of those who become addicted seeking help sooner and cooperating better with the help offered. So, overall, such patients would benefit - and thus the NHS would benefit.
3 Alcohol and narcotics abuse also need to be tackled with other policies, that are aimed at prevention and discouragement. There is, generally in society, an amazing level of toleration of such abuse, especially by persons in positions of public responsibility and influence. If sports can ban performance-enhancing drug use, then entertainment etc. should ban narcotics and alcohol abuse. By setting a firm example from the top, the message will soon get around that such abuse is unacceptable - with enormous benefits to society.
3.1 Everyone in, or aspiring to, a position of public responsibility and everyone in a position to influence the public, including entertainers etc, should be asked to sign a voluntary pledge not to take illegal narcotics or consume excessive alcohol, or drive when so affected.
3.2 Anyone who fails to sign that pledge, or who signs it and breaches it, should be excluded from positions of public responsibility and influence. All public organisations, included regulated broadcasters etc, should agree to impose this exclusion.
3.3 There would be a Trust to manage this pledge and to determine breaches, with a right of appeal. The costs of running it would be funded by fees from signatories, donations from philanthropists and a grant from the government – the grant being greatly exceeded by the savings in cost to the Exchequer, due to the substantial reduction in such abuse that will follow.
4 Councillor Karen Randolph contends that I do not “support” the NHS. Nothing in my message to colleagues indicates that I want to abolish the NHS. It is because I fear that it is heading to failure, that I put forward a suggestion to enable it to survive. What proposals does Coun Randolph have to enable it to survive? Claiming ‘support’ for the NHS, on the assumption that it will go on being funded, regardless of the nation’s ability to afford it, may get popular acclamation.
But those who want to live longer and healthier lives must surely realise that the NHS needs to take steps to ensure its own survival. Encouraging patients to do a lot more to help themselves is an essential feature of that.