Stubborn patients may be refused NHS care

Overweight patients who refuse to diet and smokers who refuse to give up could lose their right to free NHS treatment under plans being considered by Labour, reports today claimed.

People who live unhealthy lifestyles would be forced to sign contracts promising to take on certain responsibilities for their health, such as taking exercise, stopping smoking or improving their diet.

The contracts would also bind doctors to providing a certain standard of care and give patients a formal means of redress if they felt any aspect of treatment had been unsatisfactory.

The idea has been developed to help reduce the strain on the health service from avoidable illnesses linked to unhealthy lifestyles and workplace stress such as heart disease and cancer.

The plan is outlined in one of five policy documents that have been put out for consultation among Labour Party members, to be debated at the party conference this autumn. It could be included in the next Labour manifesto.

The report says that the NHS is a "free, yet finite service", and adds that: "The concept of reminding patients about the limits of the National Health Service and about their responsibility in using its resources sensibly is one we want to take forward."

The contracts would also "remind him or her [the patient] of the reciprocal nature of their relationship with their doctor".

It is not yet clear whether the contracts-would have any legal standing. The document says: "This type of agreement would not be legally binding. It would take the form of a joint statement of 'mutual good intent'."

But it also states that the contracts would put the relationship between doctors and patients onto a "statutory footing".

There is also confusion about exactly what action the doctors and hospitals would be able to take against patients who refused to co-operate and how it would be enforced.

A senior Health Department source said: "This document is about kickstarting the debate. As the NHS gets better, the issue of the patient's responsibilities becomes more stark."

Paul Burstow, the Liberal Democrats health spokesman, said: "We have had ministers micro-managing hospitals, doctors and nurses. Now it sounds like the control-freak tendency in Whitehall is aiming to micro-manage patients. These contracts are patient targets in disguise.

"The Government's performance management of the NHS is becoming excessively prescriptive and all-pervasive. The danger is that initiatives such as this will not give us a patient-centred health service. They could end up putting power back in the hands of providers - in this case those who issue the contract."

The Government has already tried through GPs to stop people smoking. Nicotine replacement treatment has been available on prescription since 1999, which has greatly increased the number of successful quitters.