Gordon Brown wants some of us to become healthier. He fears that if we do not respond to his exhortations the NHS will collapse under the weight of obese teenagers wheezing impatiently in a never-ending queue for medical attention. As the Government has staked its reputation on reviving the health service the stakes could not be higher. If we get thinner the chances of the Government succeeding are much higher.
To be precise it is not Mr Brown who is urging a new lifestyle. He would not dare. The svelte figure recommending a more robust approach to preventive health is the former chief executive of the NatWest bank, Derek Wanless. The Chancellor commissioned the report, but it was Mr Wanless who wrote it. His analysis is a natural sequel to his previous report published in the autumn of 2001 that argued for substantial increases in investment in the NHS, to be paid for by higher taxes. This earlier report paved the way for Mr Brown's budget the following year in which he raised taxes on incomes for the first time.
Mr Wanless appears to be one of the more influential members of the Government, or rather outside the Government. Indeed when Mr Brown made his first tentative case for higher taxes he did not advance his own opinion on the subject; he highlighted the views of Mr Wanless instead. In November 2001 the Chancellor made a Commons statement in which he declared that "Mr Wanless says that other ways of raising expenditure for the NHS would be more expensive to administer, punitive on business or less fair". Mr Wanless, not Mr Brown, was our guiding light towards higher taxes.
If I were to write a book about the current political situation I would call it "Mr Wanless Says". It would not be a bestseller partly because few have heard of Mr Wanless. That is precisely the point. Elected politicians hide behind obscure figures in order to advance their cause.
Who can blame them? Even Mr Wanless has been accused of being part of a nanny state, having the nerve to suggest that we become healthier. Imagine the outcry if Mr Brown had made the same points without the protective shield of a former bank manager: "Nanny Brown tells us to cut down on salt."
This is what happens whenever an elected politician dares to comment on matters that broadly come under the category of "lifestyle". Yet it is the elected politicians who put their necks on the line by raising taxes to pay for the NHS. They have every right, indeed a duty, to tell us that we have responsibilities too. There is no point improving the NHS if the rising investment is more than wiped out by an increase in flabby, wheezy patients.
How dare they interfere with our freedom to become fat? The question highlights a curious view about politicians and the role of the state. We do not want politicians to intervene and yet whenever anything goes wrong we blame them for not acting earlier. If Mr Brown or Mr Wanless can help me acquire the body of an athlete - admittedly as much of a political challenge as winning a referendum on the euro - I am happy to be nannied persistently. If my new athleticism reduces the relentless demands on the NHS so much the better. No one else will do the nannying, certainly not the companies producing the food that has made my body slightly less well honed than it used to be.
An alternative political fashion is all the rage: a government decides on the level of taxes and spending. It should then take little responsibility for what happens next. Instead it should drop all targets, devolve all powers to individual hospitals and keep clear of telling people how to live more healthily.
Indeed, Mr Wanless's report reflects that fashion in its lack of proscriptive recommendations. According to Mr Wanless, it is for the schools, the private sector, government departments and individuals to respond. The nannying is limited to exhortation.
The bashfulness of elected politicians in this matter is a symptom of a broader and persistent uncertainty about the role of the state. Following the failures of the 1970s, when politicians tended to intervene on every matter from the price of bread to pay levels in a car factory, Margaret Thatcher famously promised to get the state off our backs.
But in spite of her populist oratory she was never afraid to intervene and did so ruthlessly when it suited her. She had no coherent theory of state power and oscillated erratically between the extremes of centralisation and atomised individualism. The state was a burden; at the same time the state was a ton of bricks to be brought down on the backs of spendthrift local authorities or remaining centres of corporatist power.
Tony Blair and Gordon Brown have moved on to some extent from that level of hyperactive confusion. They are investing heavily in public services without jeopardising a largely stable economy and with a fair amount of public support. This is an achievement that some of Labour's more restive members in parliament and elsewhere do not appear to fully recognise.
But Blair and Brown are still stumbling towards a clear role for government. Blair speaks of an enabling state, a phrase much used by Neil Kinnock. Brown has highlighted the opportunities and limitations of markets for a centre-left government. Their welfare reforms, aimed at rewarding work and targeting other resources on the poorest, are positive examples of an enabling state. But quite often they have accepted their confused inheritance. They have been fearful of being seen to do too much.
A good example is their approach to the railways. In 1997 ministers were terrified of getting the blame for the travel chaos if they acquired too many powers over the trains. To their horror they discovered they got the blame anyway. Partly for this reason recent transport secretaries have played a more active role.
Another example relates to schools. When the Education Secretary, Kenneth Baker, announced in the late 1980s that schools would have the right to opt out of local authority control he used a revealing metaphor: "The Department of Education was the hub and the schools were the rim." There were no spokes then and there are no spokes now as more schools opt out of any clearly defined lines of control. In some parts of London selecting a school is the equivalent of taking part in an insane obstacle course. I suppose that this is a form of choice, but I suspect that parents would prefer to see more spokes between the hub and the rims.
As David Blunkett once stated, in one of the defining observations of our times: "Too often politicians have responsibility without power." This applies at a local and national level. Without returning to the nightmare of the 1970s, elected politicians should not be ashamed of exercising power and, occasionally, warning us about the way we lead our lives. Mr Wanless has been a valuable shield for Mr Brown. We will be healthier in a political sense when ministers feel freer to speak and act for themselves.Reuse content