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As the panic over faulty breast implants spreads to fears about dodgy Botox and other cosmetic procedures, politicians should take every opportunity to stress the role of individual responsibility. They must not only resist calls for the NHS to repair the damage (save for the small minority of cases where the procedure was carried out by the NHS as post-cancer surgery); they should also refrain from taking charge of the welfare of those women who have undergone cosmetic procedures and who are now seeking reassurance.

That might sound harsh, even brutal, but I believe there is a good reason for such restraint by our governing classes. British levels of psychological dependency on the state have been growing in tandem with financial dependency, so that we have become a nation profoundly ill-equipped to deal with adversity. Politicians of all parties have conspired in feeding this dependency, and in encouraging us to believe that the government will take care of all our needs, will ensure we have nothing to worry about, and protect us from the consequences of our own actions. Yet we now face a period in which we must somehow recover the ability to cope with less state aid and take responsibility for our own lives and for those close to us. We therefore need urgently to come to terms with the fact that government cannot answer all our problems, but that we must make independent choices, and live with the consequences. And our attitude towards toxic boob jobs seems like a good place to start.

Women who opt for surgical enhancement are voluntarily putting themselves under the knife in the belief that it will make them more attractive. Provided they pay for the procedures, they should be free to do that, and should not blame anyone else for their choice. Unlike Yasmin Alibhai Brown in yesterday's Mail, or Viv Groskop in the Times (£), I don't see these women as vulnerable, downtrodden and at the mercy of the consumer culture. They used their spending power to buy silicone breasts; other women might prefer to spend £5,000 on a wedding reception, a new kitchen or designer dresses. It really doesn't matter to the rest of us.


If we cannot even allow surgically-enhanced women to accept responsibility for the risks of their cosmetic operations, what hope can there possibly be for getting the NHS on to a sustainable footing? It is quite clear that our appetite for healthcare can expand almost infinitely, as a result of innovation in drugs, treatments and procedures. Such innovation is welcome, but there is no point in thinking that we can increase the NHS budget fast enough to keep up with it. It is inevitable that the services provided free at the point of use will have to be reduced, and some form of co-payments introduced. But we seem to be stuck with a 1950s mindset towards funding our health, a mindset that was only compatible with the most rudimentary care.

What is also clear is that the state cannot be responsible for the care of our elderly. Here too politicians have conspired to conceal from voters the blunt truth that social care is not self-funding. Pensioners have been led to believe that by paying National Insurance contributions they were providing for their old age – whereas in fact they were simply paying an additional form of income tax. Now they feel betrayed, as their own capital must be used to pay their nursing home fees. Today's politicians must be more honest and admit that funds were not set aside. And they must also be brave enough to point out to elderly home-owners – and their children – that end-of-life care is a matter of personal and family responsibility. Already many old people who move into sheltered accommodation and nursing homes for their final years are using the proceeds from the sale of their homes to enable them to buy the care they need; this should be accepted as the norm.

Pensioners who have not been able to buy a home of their own, or to put aside savings, have no choice but reliance on the state in old age. There will always be injustices here – those who struggled to set aside enough to give them independence resent state generosity to those who may have earned as much but spent their income on luxuries (including boob jobs). But such are the inevitable consequences of a welfare state which cannot easily distinguish between the prudent, the deserving poor and the merely spendthrift.

What the state can and should do, however, is to examine all areas of policy to ensure that it is providing greater incentives for prudence. Such as tax breaks for savings, for pensions, for home buying, for marrying, for childrearing, for health insurance. In short, by encouraging every act of personal responsibility which will in due course relieve the state of the burden of care. Having provided such incentives, government must then expect those who can look after themselves to do so, and to confine state intervention to supporting those who have nowhere else to turn. Only then can we expect to live within our means and take charge of our destiny. The alternative is debt, decline and dependency. Is that really what we want?

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