Leaders: Bitter pill we have to swallow

Meanwhile, their descendants, many of them cripplingly obese, will chew their way through an ever-greater percentage of a healthcare budget that cannot expand quickly enough to meet ever-increasing demand. This may seem a recipe for class and inter-generational conflict but in this dystopian future there will be a contest between the so-called deserving and undeserving sick.

The principle of the NHS – rightly lauded as a great British achievement at the opening ceremony of the Olympic Games – is more gravely threatened than at any point in its history. Equality of access to care, regardless of age, class or lifestyle is a principle that is in danger of seeming quaintly old-fashioned.

The principle that care should be determined by medical professionals, not politicians is a worthy one. Nevertheless, politicians need to be more candid about the choices that lie ahead. Rationing – of drugs, procedures and other forms of care – is already an inescapable part of the NHS. As the population ages, such rationing will become ever clearer and more controversial. By 2061, one in four Britons will be over 65 and, on even the most optimistic forecast, the proportion of GDP swallowed by the NHS will rise to more than 9 per cent

In part, rising healthcare costs are a consequence of success. Medical advances are some of the great wonders of the age. They have made the previously impossible seem routine. Life has been extended. The number of anti-cancer drugs available on the NHS, for instance, has nearly tripled since the 1970s. Diagnostic improvements mean more and more patients are treated for more and more diseases. But success is expensive. The NHS spends nearly 6 per cent of its budget on cancer care. We need to ask whether all of this expenditure, particularly in the final months of life, is productive.

The argument that containing costs at the end of life so resources may be diverted to treat younger patients may seem brutal, but it is not necessarily unreasonable or disreputable. Nevertheless, it does no-one any good to present the discussion in such binary terms as surgeon Andrew de Beaux appears to do. It is not a case of robbing the old to pay the young. What is needed, instead, is an appropriate balance.

With more than 300,000 Scots considered clinically obese, and thus prone to crippling health problems, measures to tackle this, possibly including the greater use of presently expensive surgical procedures to assist the worst-case patients, is worth considering. It would be a mistake, however, to assume that any one measure can cure all the ills associated with obesity. It seems improbable, to put it mildly, that the population has suddenly developed a genetic predisposition to obesity. Again, a balanced approach of incentives and medical procedures is needed to alleviate the pressure on health budgets. As one part of this package, ministers might consider the lamentable consequences of the decline in sport and PE provision in secondary schools.

Nevertheless, this is a discussion that cannot be ducked. Increased life expectancy is a wonderful thing to enjoy but, inevitably, it will change our country – and every other western nation – in myriad ways politicians do not appear to appreciate properly. Difficult choices lie ahead, which is another reason for discussing and starting to plan for them now.

Nuclear testing time

THE SNP leadership’s attempt to change the party’s

long-standing policy of opposition to membership of Nato is proving more difficult than Alex Salmond and his defence spokesman, Angus Robertson, must have imagined it would be.

As we report today, as many as a dozen Nationalist MSPs are poised to urge the party’s conference to vote against the move, which the leadership believe is essential to give the SNP greater credibility on defence in the run-up to the

independence referendum.

Led by the SNP’s trade union organisation, the opponents of a change of policy, backed by MSPs, are to make life difficult for Salmond and Robertson by arguing the “Yes” campaign will be weakened if the Nationalists support Nato, a military alliance which depends, ultimately, on nuclear weapons.

This latest show of strength by the party grass roots

poses a significant threat to Salmond, who has for many years completely dominated his party. Up to now, the word from the leadership to MSPs has been not even to discuss the

issue in public. Given the level of dissent, it may be that

Salmond will have to engage in this debate in public himself if he is to win an argument which is not only crucial to his party

pre-referendum but is becoming a test of his leadership.