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 up.

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 intent’.”

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 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 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 March 2002.

Would you sign this deal with your GP?

I, Margaret Smith, agree to co-operate with the following action plan to manage my emphysema, high blood pressure and irritable bowel syndrome:

1: To reduce drastically and eventually cease smoking;

2: To take moderate exercise daily;

3: To reduce my intake of salt, eat more fresh fruit, vegetables and wholemeal bread and cut back fried, fatty and fast foods.

In return, Dr George Kildare will treat me to the best of his ability for the above conditions, providing any medical assistance necessary, including nicotine-replacement therapy and blood pressure medication.

Signed
Mrs M. Smith Dr G. Kildare

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