The public health: who is responsible?

So the new English Health Secretary is throwing responsibility for pressures on the NHS back on the individual citizen? To a large extent he is right, of course. If we as a nation smoked less, drank less and were more careful about our diets there would be fewer life-style diseases requiring treatment. However, smoking has decreased dramatically and there is less binge-drinking than there used to be, so there are fewer gains to be made there. As to diet, poor choices are often forced upon consumers as time which could be spent by households in preparing good-quality meals has to be sacrificed in working extra hours in order to make ends meet. Hence takeaways and ready meals which tend to contain too much salt, sugar and preservatives, but which need little preparation time.

Government should recognise its responsibility in improving life-style. For a start, it could fully restore the cuts in Universal Credit made after the Lib Dems ceased to be in coalition (Hammond's 2018/19 budget goes only part-way to doing so) and could set a real living wage as the statutory minimum. This would enable ordinary people to make genuine choices as to what they ate.

In addition, it could tackle environmental pollution. It should take seriously the damage to the atmosphere in our towns and cities largely caused by increased private car ownership. It should go back to electrifying railways instead of falling back on polluting diesel for new trains. Atmospheric pollution particularly damages children.

It could improve living conditions by lifting the restrictions on councils and other bodies in providing social housing and bringing it up to standard. It could ensure that tenants of private landlords are allowed to make use of the law in respect of unfit housing, and not be handicapped by lack of access to legal representation.

Then it could encourage people to get out more by restoring subsidies to bus companies. (Welsh government, responsible for transport, please take note.) This would particularly help the otherwise house-bound elderly to get more exercise in the open air and sunlight.

At the end of the day, there will still be a need for professionals to give advice and to act as a first line in the fight against deteriorating health. There is an exodus of nurses induced by the government's decision to leave the EU. Efforts to fill the gaps from within the UK or the Commonwealth, who used to keep NHS nursing from collapse, have so far failed. Health may be a devolved matter, but citizenship and the granting of residence are not, and Conservatives in Westminster need to provide for those of us who do not benefit from generous private health schemes.