08/12/2014 06:56 GMT | Updated 05/02/2015 05:59 GMT

The NHS Should Treat Patients, Not Judge Them

I note that David Cameron regularly plays tennis and rides a bicycle (here he is with his pedal-pal Gideon). Whilst these are generally seen to be healthy and wholesome pursuits, they also increase the Prime Minister's likelihood of sustaining physical injuries (especially if he routinely rides without a helmet). Now, if our Overlord should ever come a cropper on the tennis court (God forbid), or fall off his bike en route to Parliament, I don't imagine healthcare workers will be expected to make a snap moral judgement about Mr Cameron's lifestyle choices before deciding whether or not to treat him. They'll just go ahead and treat him. And that's how it should be. Treatment should be based solely on medical need, right?

Well, not according to some bosses in NHS Devon, who think that their already overworked staff should add 'moral adjudicator' to their job description. A recent proposal from NHS Devon threatens to withhold surgery to patients who are smokers or morbidly obese. This latest attempt to find 'efficiency savings' in the NHS will adversely affect the already vulnerable and underprivileged in our society. Regardless of whether this proposal is actually put into practice, it smacks of the creeping moralising that has been a hallmark of this coalition government's time in office. As with all other forms of moralising, it seeks to transfer social responsibility onto individuals. This is totally wrongheaded.

As the government's own Public Health England has noted, 'Health inequalities arise because of inequalities in society, in the conditions in which people are born, grow, live, work, and age. There is a "social gradient" in health - the lower a person's position in society, the worse their health'. It has always been the case that working class people are more likely to suffer from poor diet, substance abuse, physical injury and obesity. Back in 1845, Friedrich Engels observed precisely the same patterns of deprivation and poor health in the conditions of the working class that persist to this day. This is hardly surprising when you consider the huge disparities that still exist in levels of education, income, job security, so-called 'leisure time', not to mention the exorbitant cost of 'healthy' foods. All of which makes a mockery of the idea that health is somehow a measurably moral issue, that some people are more worthy of surgery than others.

What's more, for a government that likes to bash the very idea of a 'nanny state' - busily and bossily interfering in our personal lives, telling people what's good for them, and so on - it seems odd that they should suddenly start worrying about particular lifestyle choices. And make no mistake, this government thinks that smoking, drinking and eating unhealthily - just like 'living on benefits' - are simply 'lifestyle choices'. As if the poor wilfully choose perpetual impoverishment, rather than flowing upstream in the benevolent brook of 'social mobility'. (As a side note, we should remember that smokers,drinkers and overeaters pump billions of pounds into the treasury's coffers each year, far more than is generated by Mr Cameron's casual tennis playing and bike riding).

Ultimately, no matter how much the Tories repeatedly combine moral duty and fiscal responsibility, moralising and healthcare simply don't go together. Let's stop pretending that we all have the same choices open to us, because this is the lie that the most privileged in society like to tell themselves so as to justify and protect their own positions of luxury. If we genuinely want to improve the nation's health and make the NHS more efficient, we need to tackle the causes of poor health (social inequality and deprivation), rather than refuse care at the point of need to make short-term savings? Reducing social inequality makes far more sense socially, economically, and - if you must - morally as well. Regrettably, too few people in power seem willing to make the case for a more equal society. They would rather continue to demonise the apparently 'poor lifestyle choices' of the most socially excluded.