Risky Lifestyles

The NHS Future Forum isn't really a Thinktank; not because it doesn't have a tank of people thinking about the future of the NHS and, by association, the embattled Andrew Lansley, but it's more a conversation piece as its purpose appears to be to have "conversations with patients, service users and professionals".

Its latest piece of conversation (presumably with the professionals rather than the patients) is that every encounter between a professional and a patient should include a discussion on risks asscoiated with lifestyles, focusing upon four principal elements: Diet, Smoking, Alcohol and Exercise, together with the usual passing references to mental health. The last one isn't new, given that every encounter with a health professional these days seems to include a set of questions that, if summarised, could be just the one enquiry; "...do you think you're nuts and / or  suicidal?..."



Prof. Steve Field,
or maybe it's
Lord Fellowes?

 Professor Steve Field is referred to as "The NHS Troubleshooter" (it may be just me, but should professors shorten their names - how less credible would 'Bobby' Winston or 'Bri' Cox be, after all?). Steve is in favour of this initiative and I'm wondering whether he may actually be the only one. If every encounter with a health professional went on to search for possible risks in patient lifestyle then the waiting areas in surgeries and out-patient units would be awash with people doing what they do least well...waiting.

You go to see your podiatrist to have you feet tickled and prodded. Then, after the tickling, prodding and, if you're lucky, a bit of jabbing with sharp instruments, the white-coated lady (they're always ladies for some reason) starts an encounter conversation:

"So...what did you have for dinner last night?" If you're response is "...burger, crisps and a litre of cola...", she starts furiously scribbling or tapping stuff into a computer before continuing, "...and how many fags have you had on the way here today?" followed up with "...are you going to the gym or the pub later or just round the back of the shopping centre to score some crack?" All you did was have a burger and suddenly you're on the NHS Future Forum's watch-list. All of this has also added about ten minutes to your three minute appointment and another three people to the over-crowded waiting area where everyone is sharing germs because they can't be arsed to smear the alcohol-rub on their hands in case the NHS Risk-Police assume that it's just your way of ingesting booze by some magical, manual osmotic process so you don't have to count alco-units or have another bloody 'conversation' with a health professional about your risky life-style. And after the first of these conversational encounters, you will, of course, on subsequent occasions, just lie. "Oh...last night...well, it was mung bean salad followed by freshly smoked mackerel and brocolli. Then I went for a forty-mile hike around the town, avoiding all local pubs and office snoutcast smoking areas and I feel a sort of oneness with everything and am not anywhere on the depression spectrum..."

And what about the health professionals themselves? They're hard-pressed anyway but now they'll have to be trained to ask risky-lifestyle questions and just when you've qualified to be a podiatrist you find out you're also a fat-fag-booze-slob risk-assessor as well. Then there'll be more bloody forms to fill out.

All pubs must serve alcohol
in this new, NHS-approved
plastic vessel from
January 2012

And to what purpose? Do we...or should I say, do those at the NHS Future Forum...really believe that people who choose risky lifestyles are either a) utterly unaware of the risks they take; b) in the least bit bothered, or c) worth saving anyway? And who decides what element of risk is unhealthy? The goalposts move all the time. A few years ago, a unit of alcohol was quite easy to understand and, if you could be arsed, calculate during a pleasant evening out. Now, you need a fucking calculator and a magnifying glass to read the small print on the bottle. Or there's probably an "app" for that. I cannot recall ever being at a social event or in the pub when people have taken the time to calculate the alcohol unit intake. The only question usually asked is whether it might be safe to drive and that enquiry has nothing whatsoever to do with their personal health or the safety of other road users but entirely related to the chances of getting nicked and prosecuted.

If Professor Field and his pals, however well-intentioned they may be, wish to identify and deal with risky lifestyles, then perhaps they should focus on those lifestyles that present a risk to the public at large rather than just to the public purse. After all, it won't be long before the NHS refuses to treat anyone that has ever smoked, drunk alcohol, eaten a burger or sat down a lot.

What needs to happen is that professionals of any type, not just health, should start 'conversations' during 'encounters' with their clients in order to discover any evidence of behaviour that could be 'risky'. For example, when you get your car serviced, the mechanic can strike up a chat over the bill with questions like, "When I was getting the wheel nuts out of the glove box, sir, I noticed some white powder residue in there. I like sherbert fountains too..." and then wait for a reaction. Alternatively, your bank manager can question why you've just paid in twenty thousand pounds in used notes when your normal pay-ins are five hundred quid a week in wages...oh, sorry, they're supposed to do that already, aren't they?

Apart from anything else, the NHS Future Forum's proposal over these encounter conversations is doomed just after it starts (if it ever does) once the first successful case of a member of the public that feels their human rights have been abused by a nosy-parker nanny-state in the form of a podiatrist.

Perhaps this is isn't really Professor Field's field, then...