Often in government a policy surfaces from nowhere and comes to have more impact than those that attract a mountain of words in the media. Harold Wilson's introduction of the Open University is one such example; his most life-enhancing policy as Prime Minister and one that got virtually no attention in advance, at least compared with his long forgotten pay policies.
Think also of the one measure implemented by Tony Blair that will have more positive impact on the NHS and people's lives than all his reforms and increased investment, important though the higher spending was. Let us raise a glass to the smoking ban in public places, a policy hardly mentioned in all the books about the New Labour era and which attracted relatively little attention at the time of implementation, compared with, say, a row between Gordon Brown and Blair over the wording of a speech on Europe. Of course, there were blazing disagreements over NHS reform, too, but the resulting policies, let alone those being considered by Andrew Lansley, don't save anywhere near as much money or as many lives as the ban will eventually do.
Teenagers used to discover a love of smoking in pubs. They are not able to discover the love in such convivial circumstances any more. I see a few of them outside pubs in sub-zero temperatures. They take their drags as they freeze, almost bent over in physical pain. Some of them will give up. Some of those indoors will not start. They will save the NHS a fortune.
Foolish libertarians opposed the ban at the time, but even some of those accept now that the freedom for non-smokers to sit in public places without breathing in the equivalent of 20 Marlboros is also a liberty. The former Health Secretary, John Reid, was against the move on the grounds that it discriminated against working-class people who enjoyed a smoke in their clubs. But Reid tended to make the wrong call. The smoking ban is here to stay. Let us raise another glass.
But let us not raise too many glasses. David Cameron has identified his equivalent cause, highlighting the drinking culture in the UK as the "scandal of our society". He estimates that the cost to the NHS is up to £3bn. His remedies are to be unveiled next month, but he is apparently resolved to implement a "big bang" approach rather than opt for cautious incremental measures. Let us raise a glass of orange juice. He is right to identify the urgency of the situation and must therefore counter the still vibrant libertarian instincts of some of his advisers and colleagues. Perhaps it is an instinct he shares, too. Cameron opposed the smoking ban at first, although he has since acknowledged that the measure has worked.
Some of his proposals might help ease the pressure on crazily overworked A&E wards in hospitals on Fridays and Saturdays, and a few other nights of the week, too. They include more police on patrol in A&E departments, and "booze buses" – vehicles staffed with paramedics to help intoxicated revellers. But the key is to reduce the amount of alcohol consumed. This is not easily achieved.
When Blair proposed taking drunks to a cash machine in order to pay an on-the-spot fine, the poor old Home Office Minister at the time, Charles Clarke, had to pop up to explain that the idea was a "metaphor". The more practical route is to make cheap drinks more expensive, either by statutory minimum pricing or by much higher taxes. Maybe such a move penalises moderate drinkers, but they will benefit from the lower level of disorder, and spare cash for the NHS.
From within the Government, the libertarians twitch nervously at such a prospect. In his NHS reforms, Andrew Lansley had hoped to ensure that the Health Secretary was no longer responsible for the NHS, so he is hardly going to enthuse about imposing a price on a bottle of cider. He is not alone in having faith in voluntary measures. If Cameron goes along this more cautious route, Britain will remain befuddled by booze.
Blair gave serious consideration to a "voluntary smoking ban", a classic Third Way measure that would have achieved nothing. At a Downing Street seminar I attended towards the end of his rule, on the relationship between the state and health, he expressed what happened over the ban in a revealing way. "The voters gave us permission to impose the ban," he said. Polls, focus groups and the rest of the stifling evidence that paralyses leaders into not doing very much at all suggested that the ban would be popular.
Using prices to determine behaviour is arguably more sensitive, but when that behaviour starts to improve, we will wonder why such controls were not used before. Preventive measures are the most effective route to saving the NHS money. Tackling obesity must be next. If Cameron succeeds with binge drinking, he will do more for the nation's health than he will with any of his other more publicised reforms.
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