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Prime minister’s office denies plans to withhold treatment from people with unhealthy lifestyles

BMJ 2008; 336 doi: http://dx.doi.org/10.1136/bmj.39454.706563.DB (Published 10 January 2008) Cite this as: BMJ 2008;336:66
  1. Caroline White
  1. 1London

    Gordon Brown has signalled his intention to create a bill of rights for NHS patients, sparking fears that people who lead “unhealthy” lifestyles might be denied treatment.

    In a letter sent to all NHS staff last week, to mark the start of the health service’s 60th anniversary year, Mr Brown praised staff for their achievements. But he said that the NHS needed to be as much about prevention as about treatment if it was to survive another 60 years.

    Important to this shift in emphasis were early advice, information, and support. These, he said, would not only enable sick people to exercise more choice and control but also help the well take greater responsibility for staying healthy.

    The government was looking at how such changes “can be enshrined in a new constitution of the NHS, setting out for the first time the rights and responsibilities associated with an entitlement to NHS care,” he wrote.

    A spokeswoman for the prime minister’s office strongly denied press reports that people who persistently failed to conduct a healthy lifestyle would be refused treatment under the new arrangements.

    It had been made “very, very clear” that this was not the case, she told the BMJ. “We will not be punishing people for their lifestyles and habits,” she said.

    Just a few days after the letter was sent, an interim report from the Cabinet Office’s strategy unit on food policy concluded that the British diet caused 70 000 premature deaths every year and cost the economy billions of pounds.

    A spokesperson for the BMA, which last May proposed a constitution for patients and carers as part of its vision for the NHS in England, said that decisions not to provide certain treatments to patients with particular lifestyles were made for “clinical reasons” and were based on the further threat to their health.

    Nigel Edwards, director of policy at the NHS Confederation, the body that represents most NHS organisations, said that penalising patients for their lifestyles or for failing to turn up for appointments would be “riddled with difficulties” and would hurt those who most needed help. “A constitution should be about values and aspirations,” he said.

    But he warned: “If you are going to give the NHS more to do, you need to make sure that you don’t take away from what it’s really good at [diagnosis and treatment].”

    “We are quite good at secondary prevention, but we are not very good at primary prevention. Many NHS staff were ill equipped to do it, he added. “But the assumption is that there are huge savings to be made, and I am not entirely sure the evidence is with us on that,” he said.

    Footnotes