Patients face having to meet conditions to qualify for free healthcare under a new “contract” between the National Health Service and its users.

Smokers or people who are chronically overweight may have to agree to exercise or to other changes in their lifestyles in return for NHS treatment, as part of the move.

Patients who miss or arrive late for hospital appointments may have penalties imposed on them and “health tourists” who travel from abroad for free NHS treatment face a clampdown.

The moves are heralded as Gordon Brown embraces plans for the first constitution for the NHS in its history, setting out the terms under which patients are eligible for free healthcare. In a new year message today to the 1.3 million NHS staff, Mr Brown said that a NHS constitution would set out the “the rights and responsibilities associated with an entitlement to NHS care”.

The move comes as he shifts the focus of the health service towards preventative care. Plans for an NHS constitution will be revealed this year when the health service prepares to mark the 60th anniversary of its foundation by the postwar Labour Government of Clement Attlee.

A spokesman from Downing Street played down the prospect of sanctions if people refused to comply, saying that it was too early to discuss details but emphasising that the proposed constitution would not change the principle underlying the NHS of a service free at the point of use, accessed by all.

But sources at the Department of Health said that laying out what was expected of patients in return for healthcare would mean addressing issues that have posed dilemmas for health professionals for years.

One source said: “If you are smoking too much should you be entitled to an operation? Should we say you can have an operation if you give up smoking and change your pattern of behaviour? Or, if you don’t turn up for a hospital appointment should there be a penalty for that?”

The exercise is also expected to rewrite the rules that allow free care to anyone ordinarily resident in the United Kingdom, which have prompted long-standing complaints that these are open to abuse by “health tourists” who falsely claim residency.

The NHS constitution, to be a centrepiece in the review of the service by Lord Darzi of Denham, the Health Minister, in the summer, will also set out for the first time clear divisions of responsibilities between the Department of Health and primary care trusts and hospital trusts. Although this is likely to devolve some extra powers to local trusts it will keep the structure of the NHS being answerable to Parliament through ministers and reject the plan of the Conservatives to have an independent board to run the NHS.

A source close to Mr Brown said: “There is no suggestion of an independent NHS, that is not something he is particularly attracted to.”

Health policy will become the focus of a series of political battles in the coming weeks, with David Cameron, the Conservative leader, making a speech tomorrow to mark the 60th anniversary of the NHS and preparing for two days of visits to hospitals in Manchester and West Yorkshire.

Mr Brown is also planning a speech in the next fortnight on his plans to develop preventative healthcare, with greater emphasis on medical research, vaccination and inoculation, and tackling obesity and sickness, which aides say is increasingly his priority for the health service. Employers will also be expected to take greater responsibility for the health of their staff.

In his message to NHS employees, Mr Brown used Blairite language when he told them to prepare for further reforms to deliver “personal and responsive” care. Mr Brown wrote: “These steps . . . will require a broadening and a deepening of reform to ensure that the NHS as a whole attaches the same priority to a personal and preventative service as many of you already reflect in your own day-to-day decisions.”

Key areas for reform are likely to include improved out-of-hours cover by GPs’ surgeries, moves towards individual users’ budgets for social care and using technology to find the patients who are most at risk of ill health, for early intervention.

From top to toe

— The NHS is the largest organisation in Europe

— It began on July 5, 1948, when Aneurin Bevan opened Park Hospital in Manchester

— It offers 120 different operations for bunions, a surprisingly complicated operation with a long and sometimes difficult recovery time

— Cataract operations are one of the most common, with up to 300,000 a year

— Prescription charges of a shilling (5p) and a flat rate of £1 for ordinary dental treatment were introduced on June 1, 1952

Source: The NHS

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