Medical Life

So nanny is being shown the door. After years of faithful service she has been told to pack her bags and be on her way. From here on we will run our own lives, without her constant chivvying – making our own choices, for good or ill.

Andrew Lansley, the trim 58-year-old health secretary, is impatient with Government efforts to make us fitter or slimmer or healthier. He even took an ill-advised pop at Jamie Oliver, the irrepressible chef and public hero, for his campaign to improve school meals.

Reports that the Food Standards Agency was to be abolished were denied yesterday, but last week's revelation that funding of the Government's Change4life campaign to curb soaring obesity rates is to be handed to food firms including Mars, Cadbury and Coca Cola, was not. The direction of travel is clear. When it comes to deciding what is good or bad for us, we are on our own.

Some will welcome this – those robust individuals who abjure Government regulation as unwarranted intrusion into individual lives. Not me, however. I am an unashamed paternalist – we just need to think more cleverly about paternalism.

Julian le Grand, professor of health policy at the London School of Health Economics and a former No 10 adviser to Tony Blair, has an interesting take on this – he calls it libertarian paternalism. Instead of requiring people to make healthy choices – by giving up smoking, taking more exercise, eating healthily – he has suggested turning things around so the automatic default option is the healthy option, and people have to choose deliberately to depart from it.

Among his suggestions are a proposal for a smoking permit, which smokers would have to produce when buying cigarettes, an "exercise hour" to be provided by all large companies for their employees and a ban on salt in processed food.

The beauty of this idea is that instead of opting in to healthy schemes, people would have to opt out to make the unhealthy choice – by buying a smoking permit, choosing not to participate in the exercise hour or adding salt at the table. The ingenious thing about this approach is that it preserves individual choice, and can therefore be defended against charges of a "nanny state". You are not being made to do anything or being banned from anything. There is no prohibition. It is a softer form of paternalism.

Lansley, on present form, is unlikely to be interested. Yet the evidence on the benefits of paternal regulation is staring him in the face. The proposal to ban smoking in all enclosed public spaces (including, most controversially, pubs) split the government and provoked a prolonged political battle over "nanny state" Britain. Instead it triggered the biggest fall ever seen in smoking in England, with over two billion fewer cigarettes smoked in the first year. A study last month showed, more than 1,000 heart attacks were prevented.

We may not like nanny but we are going to miss her.