For a government in the middle of an efficiency drive, it shows remarkable lateral thinking to come up with a scheme that will divert millions of pounds of NHS cash away from patient care.
Obese people can't have operations in many parts of the country, despite paying taxes like anyone else, because the NHS is short of cash. But ministers have decided to slip one more vital priority into the list of work given the value-for-money green light. Is it more beds, more staff, more drugs? Er, no. It's advertising. For the first time, the government announced last week, organisations providing NHS services will be able to market themselves to the public.
Why? Because it's good for patient choice, they say. Only it's not.
When it comes to making choices about healthcare, patients need impartial information presented by an authority whose credibility is beyond question - this is why regulatory bodies now publish reams of information and ratings for all sorts of NHS organisations.
Since this information is available, why should NHS organisations be given permission to spend taxpayers' money on advertising and marketing their services, a process that presumably involves repackaging this same information and giving it a positive spin - ie making it less reliable and accurate, and less useful for patient choice?
Reminding patients that services exist is a good idea - people may not realise that there is a GUM clinic nearby until they need it; they may not be aware when specialist clinics happen at their local GP practice. But this sort of information can be flagged up - and is already - via posters in NHS buildings, information leaflets and websites.
NHS spending has tripled since 1997, and benefits to patients have been great - less waiting, fewer heart disease deaths, more GPs and nurses etc - but nothing like as great as they should have been.
Offering patient choice on the NHS was never going to be cost-neutral, but decisions around how to deliver it often seem emblematic of the profligate decision-making that has seen much of the spending growth apparently go to waste.
To choose, almost by definition there needs to be an excess of capacity, rather than just enough operations, appointments and plasters to meet demand. Hence the government's decision to pay over the odds to set up independent sector treatment centres, which often sat idle because patients chose to stick with the NHS hospitals they trusted.
Now, advertising will be brought in, with no limits apart from a weak-sounding decree that it shouldn't be ‘excessive'. This cannot be fair - NHS organisations in parts of the country with historic low levels of funding will be less able to compete. But capping advertising spending would be bad, the government said in its ‘Code of practice for the promotion of NHS-funded services', because it would be ‘too restrictive, especially for independent sector organisations'.
Private companies must be tempted in at all costs, the government believes. What this means for the future is uncertainty for existing NHS organisations at all levels, and on the face of it, the potential for a lot more cash to go to waste.