The real weight of public sector promises

I’ve been asked to comment a few times on the story of Paul Mason, the man who has needed NHS care and surgery costing around £1 million over the last ten years because of his size. Reports that he was 70 stone at his heaviest mean he was the fattest man in the world; it’s a shocking and ultimately sad story. But it’s one that has provoked reaction and debate because to many people it doesn't seem fair. No one would envy the position he has been in, and we would never suggest he shouldn’t be given treatment when in medical need, but it’s a lot of taxpayers’ money to look after just one person.

The story has been exacerbated by the news this week that he may be planning to sue the NHS. This has angered many people, including Ann Widdecombe who wrote that she agreed with the TPA yesterday. It seems wholly ungrateful – the recent Channel 4 programme on his plight showed the effort and lengths went to by a whole team of medical staff to get him mobile again. Experts were needed to transport him, build a bed, reinforce surgery floors and the top Gastroplasty doctor worked to reduce his weight with surgery. So how on earth can a person then blame the NHS for letting him get to that size?

Some of the answers lie in the debate itself. The story "should gluttons be punished?" featured on BBC’s Big Questions on Sunday morning, and one contributor said that trials are underway to prove taxpayer funded incentives work, and should be rolled out on a larger scale to Britain’s growing population. But it is wrong for the government to interject at the intent stage. Paying taxpayers' money on schemes that have questionable value is foolish, and it’s not the government’s role to take on responsibility – and consequently blame and liability – for an individual’s decision.

The age-old concept of personal responsibility keeps being brought up but seems to be sorely lacking from the suggestion that incentives are the solution. The belief that the government has failed an individual – sometimes resulting in the kinds of lawsuits filed by Mr Watson – will only gain traction and credibility as the government expands its remit of where, what and who it takes responsibility for. Treatment is one thing that the NHS is currently responsible for, and early treatment can lead to positive health outcomes and save money long-term. But intervention to manage someone's intent is not something the state can or should take full responsibility for.

However, those who are paid more when more is going on in the public sector, i.e. those who make the big decisions on how our money is spent, will always argue for more initiatives (incentives to lose weight, advertising budgets to tell people chips contain fat) that are not only ineffective and a waste of money but make the government as culpable for their failures as they are laudable for their successes. (Of which there are few in this case – despite incentives, personal trainers, public health awareness campaigns and advertising strategies obesity has continued to rocket.)

After all it actually shouldn’t be the government’s or the NHS’s fault every time something goes wrong. Of course they both make some big mistakes, but in situations like Mr Watson’s they are being criticised for not having taken more on. But they have themselves to blame. The growth of the state over the last couple of decades has no doubt engendered this culture; that somehow someone else is to blame because for an individual’s personal choices.

Those with a vested interest, who hope to make an easy buck from the public sector, will always argue that more should be done. But government intervention – and to an extent the ideas of David Cameron’s ‘Nudge Team’ – implies that individuals don’t need to decide their own lifestyle for themselves, motivate themselves or to teach their own children. They can absolve themselves of these decisions and expect these as services from the government. So the answer, more broadly, is that the government must start stepping back and stop impinging on personal choice – the growth of the quango state, burdensome tax hikes to fund spending binges and the mushrooming of public sector executive pay are all tangible and pernicious results of state expansion. And so are ridiculous lawsuits against the NHS.

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