A few nights ago, during the graveyard shift in A&E, a colleague sent me a clip from the classic BBC sitcom, Yes, Prime Minister. “The Smoking Ban” episode shows PM Jim Hacker vowing to take on the tobacco lobby — something his Cabinet Secretary, Sir Humphrey Appleby, says “no man in his right mind could possibly contemplate”. When Hacker, quoting from a medical report, explains that smoking-related diseases cost the NHS £165 million a year, Sir Humphrey puts forward the case for tobacco tax revenue:
“It has been shown that if those extra 100,000 people had lived to a ripe old age, they would’ve cost us even more in pensions and social security than they did in medical treatment. So financially speaking, it’s unquestionably better that they continue to die at about the present rate!”
Anyone who’s worked in the National Health Service for more than a few months would, depressingly, recognise this kind of equation.
Those episodes were first broadcast in 1986, when the tobacco tax generated £4 billion in revenue for the government and smoking-related diseases did indeed cost the NHS £165 million a year. Last year, the tobacco tax raised £8.7 billion for the government — but smoking-related illnesses cost the UK healthcare system £2.5 billion per annum. Nevertheless, a smoking ban has never been seriously considered. Behind the gallows humour at the heart of Yes, Prime Minister lies a bleak fact: the state is happy to kill off the weak to balance the books, or even make a profit.
This cavalier attitude to death rather defined the Government’s attitude to the pandemic, as it spread through hospitals and was encouraged into care homes, pushing the NHS to breaking point. In hospitals, we’re battling it still. When Omicron started spreading at the end of last year, we were told it wasn’t as dangerous as previous variants — but that might just have been because patients and the public were more vigilant. Now, vigilance has waned. With most Covid mitigation measures nothing but a memory, hospitalisations could spiral out of control again. And it’s now predicted that, because of a lack of exposure during lockdown, flu deaths will be very high this year. This winter, according to The Lancet the return of influenza as a major public health issue appears “inevitable”.
Then factor in the cost of living crisis. People are not going to be able to heat their homes. People are not going to be able to put food on their tables. People are not going to be able to put fuel in their vehicles to go to work to earn money. People are not able to afford prescriptions. People are going to have to choose whether to feed themselves or their children. Isolated, vulnerable people are going to be more isolated and more vulnerable. Abused people are going to be more abused.
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