Yes, the NHS is facing some weighty issues

Whenever you hear a politician make an announcement, there are two things that should go through your mind. Who wrote the speech and who was the adviser behind this latest initiative. With recent health policy announcements it’s often difficult to tell who the speechwriter was. Style is overtaken by substance because the Department of Health farms out its speechwriting to an array of writers who are ready and waiting to do its bidding. So bland is the order of the day.

Advisers are a different matter. They go in and out of favour according to who is in the hot seat at Number 10. The current supremo is the effervescent Greg Beales – a former management consultant who cut his teeth under Blair but survived to tell the tale and is now indentured to Lord Brown for the next year at least.

Mr Beales is an affable chap who is clearly very clever. Listen to him talk about the future of the NHS and you begin to believe in a world where commissioning works in harmony with payment by results and fully-informed patients take responsibility for their health. The NHS constitution, he says, should operate like a contract that offers a guarantee of service levels as long as certain conditions are fulfilled. If you fail to turn up for three GP appointments in a row, you can no longer expect to be treated within four hours when you land in A&E with appendicitis.

The desire to tailor the NHS according to need and personal responsibility is understandable given shrinking NHS budgets and growing expectations. However, Mr Beales should take care when he starts on the blueprint for the NHS Constitution. He might kick off with missing GP appointments but where does it stop? Is he really going to suggest that the clinically obese risk losing their rights to treatment unless they sign up to personal weight-loss programmes.

The irony is that his talk of weighty issues facing this NHS comes painfully close to home. He is not a slim man by any measure and it’s very difficult not to question his commitment to a healthy lifestyle. Does the lure of a Big Mac grab him after a late night putting the finishing touches to the NHS master plan? Perhaps that’s why someone suggested he take a back seat at the launch of the government’s obesity initiative.