Fat people will
have to diet if they want to see the doctor
OVERWEIGHT people and
heavy smokers would have to sign contracts promising to diet or give
up cigarettes in return for treatment, under radical new plans being
drawn up by Labour.
Written contracts would set out the patient’s responsibilities while
offering them help to cut down or quit smoking, lose weight, take
more exercise or eat a more nutritious diet, The Times has learnt.
Those who failed to keep their side of the bargain or kept missing
appointments could be denied free care.
The contracts would also bind doctors to certain standards of care
and to providing a formal channel of redress if they fail to measure
The move comes amid growing concern about the strain on the health
service from avoidable illnesses linked to smoking, alcohol, bad
diet and workplace stress. For example, Britain suffers a relatively
high incidence of heart disease and lung cancer.
The plan is outlined in five new policy documents that have been put
out for consultation among Labour Party members. They will be
debated at the party conference this autumn, agreed in 2004 and form
the basis of the next election manifesto.
The health service document describes the NHS as a “free, yet finite
service” and states that Labour intends to stop wasting care
resources. “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 agreements would set out the standards of care the patient
should expect, but also “remind him or her of the reciprocal nature
of their relationship with their doctor”. There appeared to be
confusion over whether the contracts would be legally binding. The
document seen by The Times states that it would put the relationship
between doctor and patient “on to a statutory footing”, although it
says later that “this type of agreement would not be legally
binding. It would take the form of a joint statement of ‘mutual good
Nor is it clear exactly what sanctions would be taken against a
patient who refused to co-operate. This is expected to be addressed
during the consultation exercise and a senior Health Department
source said: “This document is about kick-starting the debate. As
the NHS gets better, the issue of the patient’s responsibilities
becomes more stark.”
Paul Burstow, the Liberal Democrat health spokesman, said: “We have
had ministers micromanaging hospitals, doctors and nurses. Now it
sounds like the control-freak tendency in Whitehall is aiming to
micromanage patients. These contracts are patient targets in
“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 NHS.
They could end up putting power back in the hands of providers — in
this case, those who issue the contract.”
Persistently violent patients have already been warned that they
will be denied treatment and the Government is considering fining
patients for missed GP appointments — of which there are an
estimated 17 million a year. The Tories have said they will charge
for abuse of the system.
The Government has also tried through GPs to stop people smoking.
Nicotine-replacement products have been available on prescription
since 1999 and the number of successful quitters reached 227,300 in