Fat is a class issue

There seems to be a backlash against people who are obese as evidenced by articles that have appeared nationally in the Express and Mail on the number of people who are taking stomach-shrinking surgery.

Issued by the NHS Information Centre, new figures show the number of people having stomach shrinking surgery to help them lose weight soared from 480 in 2004 to 4,246 in 2009, costing the state an estimated £29 million.

Matthew Sinclair, research director at the Tax Payers’ Alliance, is quoted in the paper criticising the increase, saying: “So much is being spent on surgery for the obese instead of on treatment for unavoidable diseases.”

Alan Kaminski from Abbey Hulton who had the operation is featured in the Sentinel deploring what he considers to be an attack on the obese and indicating that for a number of other health reasons such as diabetes and his weight that exercise and other methods proved unsuccessful

Three years ago, Alan found himself in an appalling position when health bodies haggled about who should carry out his treatment and he found himself having to spend 200 days in the UHNS whilst the arguments were sorted out.

Now I know Alan Kaminski who lived in Eaveswood Road when I was growing up. I don’t want to embarrass him but Alan is a highly intelligent and extremely capable man. For some years he was a worker at Hanley CAB I would think that he would make an excellent Councillor for the Abbey.

But there is an issue over the increase in obesity. You only have to look around the public places of North Staffordshire to prove this claim.

I am a fan of the Mitchell and Kenyon series of documentaries of film on lives of people in Edwardian England based on film discovered in Blackburn about a decade ago. I was watching a clip of working people parading around Blackpool in 1904. Not one of the people in the film was overweight. Fat in the context of 1904 was a rich man’s disease characterised by the bulky presence of King Edward VII described by Kipling as a “corpulent voluptuary” which probably explains why Kipling never got a knighthood.

But the film evidence is there. Obviously hard manual work, diet and access to food and skills in cooking are all part of the problem. But it always seems to come down to a culture of blame and the fat are usually labelled as lazy, stupid and lacking control which is why I mention Alan Kaminski who clearly is not stupid or lacking in focus.

A couple of years ago I heard Judith Bell, Public Health Director of North Staffs Primary Care Trust on BBC Radio 4 on a programme in a series on the 60th anniversary of the NHS justifying the conditions imposed on patients who drink, smoke or who are overweight before they can access procedures such as surgery. The radio programme gave examples of the sort of protocols that are currently in place for those patients who for example have a body mass index of over 30.

I would imagine that these policies would have been accepted at board level.

They certainly raised comments from members of the panel who were debating the issue there was talk of “management diktat” and a “black and white approach” adopted by North Staffs PCT. Perhaps the sharpest comment came from a spokeswoman from the Patient Association who was scornful of the consequences of such moralistic decisions on people in poverty and that it was”easy for skinny rich people who make these decisions, much harder if you are having a tough life”.

She was supported by a Rotherham GP on the programme who gave an example of a patient whose knee injury restricted her ability to tackle her obesity which she dearly wanted to do. He regarded the approach as unethical. All the critics of the restricting or denying access approach suggested too much of a “stick” approach, they felt that to make changes requires time, energy and money factors as well as support which can be lacking.

To cite my own experiences of health services in Leek I have found it very difficulty to access the exercise on prescription scheme which eventually proved insurmountable or discovering that the weight control clinic at my practice I use has had funding removed by North Staffs PCT. It therefore seems paradoxical to demand changes by individuals and not provide the opportunities for self help or support within primary care.

But my main objections fall into two main categories. As David Edgar the distinguished playwright suggested that by denying treatments it means that you are denying treatment to people who may have been paying taxes and National Insurance contributions for many years. Where would be the fairness in that as well as being against the ethos of the NHS! Similarly, if it a question of punishing or checking unhealthy behaviour then the logic would also mean that you would also restrict access to services, for example, for those who did not practice safe sex or those individuals who engaged in sports or activities which have high risks of injury.

Secondly, the whole issue smacks of a patrician, top down attitude to health and social care. It invokes the 19th century attitude to the poor and of deserving and undeserving cases. In short, it is more to do with morality than health. It reminded me of a quote by an eminent figure from that century the great philosopher and social reformer JS Mill in his essay “On Liberty” who captured this attitude which has never gone away, “Wherever there is an ascendant class a large part of the morality emanates from its class interests and its class feelings of superiority”. No doubt these feelings of moral censoriousness in authority existed before he was writing in the 1850s, but certainly they exist now as evidenced by North Staffs Primary Care Trust in 2008.

As one Dorset GP explained in the last minutes of the programme the approach being applied by North Staffs PCT was entirely the wrong approach, the impact of social deprivation should be directed upwards towards Government’s whose actions are seeing an increase in poverty rather than in downwards in chivvying the patient to make changes that they will find difficult.

Nu Labour- Goodbye and Good Riddance

There is a pleasant country walk that goes from the Haregate Estate in Leek to Tittesworth Lake. It takes about an hour to do and there are excellent views over to the Roaches.

Along the walk are a series of benches, which have been provided by the local PCT so that people can sit and admire the views. Cut into the 8 benches is a series of health promotion messages about obesity and exercise and the need to raise your heart beat.

I cordially detest the messages and have to think that they are pointless what is the reason for directing messages at people who are undertaking some moderate exercise but I hate the messages for the simple reason that they sum up the ethos behind Nu Labour perfectly.

If I were to characterise the last Government I would be using one word that word would be control. The messages on the benches seem to perfectly encapsulate that. It suggest that the people cannot be trusted and only we the middle class professionals who devised the idea and used public money to have the messages inscribed know what is good for you. It says we really despise you for your unwillingness to accept the messages we give you.

Of course sometimes the loathing spills out such as Brown at Rochdale but the evidence has been all around for some time.

” Friends of the people” sometimes I struggle to find a connection.

I have experienced it myself. On the occasion when I took my 3-month-old daughter to a Sure Start Centre in Ellesmere Port and was told that I, as a white man, I must be a bad parent. I have seen it at innumerable meetings when some one makes a disparaging comment about the people of Stoke because they are stupid or fat or lazy or vote BNP. The people who make these comments are usually middle class professionals who live some distance away from the City. They use their prejudices to further seek control over the lives of the people they have so little time for

My other example, which I like to use to illustrate the folly of Nu Labour, was the setting up of the School Food Trust following the expose of Jamie Oliver on the condition of catering in schools around the country. The response of Nu Labour was to set up the Trust based in Sheffield. My partner at the time was working in a school kitchen. The findings of the TV programme on the general poor quality of school food led to more food preparation time for the school cooks. However it did not lead to more pay. On the other hand the newly set up quango in South Yorkshire quickly acquired a Board of Nu Labour cronies as well as well paid posts. I seem to recall a media officer employed on £95,000 a year.

Then there were the targets. Not a week seemed to go under the previous regime without some manifestation of the consequence of the target culture. Trolleys in hospital corridors have their wheels removed so that they become beds thereby meeting a target. Schools teach to the league tables when the number of 16-18 year olds not in education or further training rose. Police Officers spending less time on the beat and more on paperwork to prove that they are meeting a central imposed agenda.

Social Workers occupy much of their time huddled over computers imputing data rather than dealing with their clients. Everyone it seems has a target and it seems to be getting in the way of the ability of people to provide a public service.

There are many reasons why people should have been in open revolt by the way that in which many have to leave professional judgement outside their place of work. Let us hope the new Government has learned the lesson.

Let us hope that if the axe is to fall it falls on the panoply of the target industry. It has been calculated that performance management costs an average size local authority of around 300,000 £1 million a year. Then there are the consultants that are employed. Then there are the computer systems that have to be developed to monitor this questionable system. Costly systems which have blighted the management of the NHS, farm payments, child benefit, employment records and tax credit. And of course an aspect of the performance management culture is the impenetrable jargon filled language, which frequently attends it. All culminating in the grotesque spectacle of an authority have to have passed all its targets and deemed a 3 star authority at the same time as Baby P was happening.

There were of course were the other failings. The dalliance with the finance industry and the light touch regulation that lead to a. Finance Services Authority which failed to protect the public from risk. The wars, the overweening arrogance that led it to blatantly ignores the wishes of ordinary members over uses of council house revenues, the 10 pence tax fiasco, the growing inequality, ID Cards, the surveillance society meant to combat terrorism, but used to see what people were putting in their bins or living within a school catchment area. I could go on and perhaps you have your own favourite.

Now it seems to me that the candidates for the leadership of the Labour Party have sworn not to follow the mistakes of the years of Nu Labour. I do not think that this goes far enough and that they should be made to rub their noses in the mess that they have created.

I have been watching quite a few films about US Presidents as well as reading avidly. FDR strives me as a individual who believed that politics could be made to work for people and the role of government was to mobilise individuals to deliver a good society. That is what I want from my politics to believe that an individual through the democratic process could work for the betterment of society and the crucial difference from the failed Nu Labour experiment in communities that are empowered.

The terrible verdict on Nu Labour that despite the good will and the popular mandate it had in 1997 it allowed an opportunity that it was given to be wasted.