NHS: A contracting service?

New Labour have floated the idea of 'patient contracts', offering access to treatment in exchange for a commitment to lifestyle change.

For example, if smokers wanted nicotine patches to help them give up, they might also have to agree to go to classes to help them quit. The proposal has raised the possibility of patients being refused treatment if they don't sign up. However, a New Labour spokesman has denied that this would be the case. But if the contracts aren't both compulsory and binding, what is the point of this proposal? The buzzword seems to be 'responsibility'. '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,' a New Labour spokesman told the BBC. So, it's not the government's fault that you can't be treated, it's all down to the people who live bad lives and use up the resources intended for the saintly. The response of critics seems just as bad, though. 'People need help from the NHS and if changes are to be made there must be support available to them,' commented Lyndel Costain, of Dieticians in Obesity Management UK. Both the government and its critics thus have a rather low opinion of the patient as a victim of their own uncontrollable urges, in constant need of therapy. We need doctors who will help us enjoy the pleasures of life for as long as possible, even if those activities are not necessarily good for us. We don't need to be treated like naughty children who have to confess our wickedness, especially when the links between some of these habits, like eating too much of the 'wrong' food, and disease are weak and far from proven.

If New Labour really wanted to cut those waiting lists, they might like to do something about all those unnecessary health panics that fill the surgeries with the 'worried well'.

Anger over health contract plan, BBC News, 3 June 2003

In praise of bad habits, by Peter Marsh