On Wes Streeting's Weight Loss Injections

It sounds like a scenario straight out of Black Mirror. Unemployed people who are overweight are forcibly subjected to injections that will shed the pounds so they can get off the dole and make them. Unsurprisingly, Wes Streeting has been forced to deny this is the objective of his weight loss scheme that has exercised headline writers this week. On Sunday's Laura Kuenssberg, Streeting said no one was going to be forced to do anything. Instead, he was defending a five-year trial involving a sample of 3,000 people living in and around Greater Manchester. Participants will receive the weight loss drug Tirzepatide, and researchers will track the rates of obesity-associated conditions and the number of sick days they take. The impact on their employment status is but one measurement the project will be taking.

For once, Streeting is telling the truth. This is not an experiment in dystopic social engineering. The trial's plan wants to find out what care packages are most appropriate to those who receive this treatment, as well as tracking the drug's long-term effects. If it works as advertised then it could be beneficial and life-changing, and will have knock on effects where obesity-related NHS care is concerned. In other words, what concerns is less the trial and more the political uses to which this could be put.

For Streeting, there are obvious political benefits. Cutting the £11bn spent on obesity care by making it increasingly superfluous has its attractions. As he said, he hopes the success will speak for itself and encourage others who need it to take the drug, which ties nicely in with his vision of the NHS as a preventative as opposed to a care service. A couple of wins that will finesse his credibility when the inevitable run at the leadership comes. And there is the other side, of making the NHS a guaranteed market for Tirzepatide and other weight loss drugs. But more importantly, as a tool of governance. For Streeting, the Department of Health is really an economic growth department. He talked about this in relation to boosting the life sciences at his Tony Blair Institute speech a week after taking office, but the obvious implication is that he sees his brief as fixing people so they can be fed back into the labour market. This government's number one priority, heard ad nauseum, is growing the economy so decent public services can be provided for. Everything else is subordinate to the aim of our producing profits for other people.

But it's wider than that. Streeting has jumped on this in the same week Liz Kendall said job coaches would be let loose on the mentally unwell to get them out of clinics and into jobs. She argued that getting into work can improve mental health, which is something that Iain Duncan Smith used to often say when challenged about the axe he took to social security. In context, for Streeting, Kendall, and the rest of them, upping the conditionalities of social security and reducing welfare to an authoritarian instrument comes naturally to them. They (mostly) come from modest backgrounds and made it to the top, so why can't anyone else? Hence unemployment is a consequence of individual poor choices or, in this case, infirmities. Get them fixed and the benefits bill can come down. Never mind the fact unemployment is a structural issue and that the people out of work always exceeds the number of vacancies. Whether they're dealing with obesity or mental health difficulties, the onus is on them to sort themselves out and be available to employers. If they don't cooperate? There are sanctions available for that.

There are differences between Labour and their Conservative opponents. Keir Starmer wants to modernise the state. The Tories want to wind it down. But when it comes to the fundamentals of supporting the most vulnerable in Britain (or otherwise), they are one. Compassion and care are words in a dictionary to these people. But there's another C word that comes through loud and clear: cruelty.

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