Drunks who are treated for injuries at accident and emergency wards should have to pay for their treatment, the Liberal Democrats say, signalling a Blairite shift in the party’s health policy.

Norman Lamb, the Lib Dem health spokesman, argues that patients must take greater responsibility for their actions and pay for self-inflicted problems, particularly if they are surly or abusive to NHS staff. He also believes that pubs and clubs should have to pay a contribution if they repeatedly send casualties to A&E.

The Blairite plan, with its emphasis on personal responsibility and a greater need for market mechanisms, could unsettle some members of the party. Mr Lamb indicates that he does not favour greater investment in the NHS, saying that existing money must be better spent. To do this he is proposing an extension of patient choice, greater individual responsibility and personalised budgets, allowing local health boards to accept private funding.

“Ninety-five per cent of taxes are raised centrally compared with the EU average of 60 per cent. Power resides where money is raised. This strangle-hold has to be broken,” says Mr Lamb.

Other proposals include training nurses to advise patients on which doctors are good or bad; and getting the Department for Work and Pensions to fund physiotherapy to help the long-term unemployed get back to work.

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