Obese may be denied priority NHS care

Patients with 'self-inflicted' illnesses face discrimination

Smokers, people with alcohol problems and the obese could be denied priority treatment on the NHS if they do not try to change their lifestyle.

The Cabinet is discussing the controversial idea as part of a drive by Tony Blair to secure his domestic political legacy by pushing through a final round of public service reforms before he departs next year.

Ministers will confront a panel of 100 ordinary people with some of the "tough choices" facing the Government under a consultation exercise giving the public a direct say in the new policies. One question will be whether people whose lifestyle makes them ill should get the same priority as other patients. This would mean changing NHS guidelines saying that people should not be discriminated against "even if their illnesses are to some extent self-inflicted".

A Cabinet review group on public services was shocked by the scale of the burden caused by people's lifestyles. "Ministers were shocked by the fact that half of all years of healthy life are lost as a result of behavioural factors (e.g. smoking and diet)," a Government source said.

Ministers want a "cultural change" in public services so the state can support and encourage people to change their behaviour to improve their life chances and well-being.

They also want to extend the number of "contracts" between the citizen and the state, such as the £30-a-week education maintenance allowances paid to over-16s who remain in further education.

Experts warned this month that obesity, which costs the NHS £7bn a year, could bankrupt it if left unchecked and predicted that the proportion of obese adults would rise from one in five to one in three by 2010. Smoking-related diseases cost an estimated £1.7bn a year, with the same amount spent on alcohol-related problems. The treatment of alcohol-related harm, such as violent crime and traffic accidents, costs an estimated £20bn.

Downing Street sources said no decisions had been taken on whether to change the guidelines and stressed that the public would be asked their views on the issue first. The suggestion is bound to provoke criticism. Forest, the pro-smoking group, has claimed that some smokers have already suffered discrimination. It argues that tobacco revenues, which bring in £7bn a year for the Government, dwarf the cost of smoking-related illness.

The cabinet group, one of six drawing up the Blair Government's last policies, will also look at how public satisfaction measures can improve state-run services. Ministers will try to learn lessons from retailers like Tesco, which has used the technology behind its Clubcard system to offer a more personalised service.

The 100 people, a representative cross-section of the British public, will be recruited across the regions in the new year and organised lobby groups will be excluded. In February, they will see the papers discussed by the six cabinet groups and, in March, a public services summit will be held in Downing Street at which the "people's panel" will reach decisions. These will be presented to the Cabinet in mid-March.

Hazel Blears, the Labour Party chairman, is looking at other ways in which the public could influence government policy and the way that services are run.

A Blair aide said: "This process of public engagement recognises that politics is changing. The public level of expectations is rising both in terms of the provision which they receive and the right which they have to influence those services. It will identify in more detail the areas which the public want us to focus on and develop a series of radical and progressive solutions."

The cabinet reviews have already provoked controversy. A paper for the security, crime and justice group, leaked at the weekend, suggested that crime could rise for the first time in more than a decade as economic growth slows, and that the prison population, already at a record 80,000, could rise to 100,000 over the next five years.

The Government has promised an extra 8,000 prison places but it is not clear how they will be funded. The Treasury has frozen the Home Office budget in real terms from 2008-11 other than for spending on security and anti-terrorism work.

Yesterday David Davis, the shadow Home Secretary, challenged the Chancellor, Gordon Brown, to address the "chronic shortage" of prison places. He said: "All we have seen from Gordon Brown has been a miserly approach which, as well as putting the public at risk, is short-sighted. The cost of having a serious criminal free on the streets to commit crime far outweighs the cost of imprisoning and rehabilitating that individual."

'Self-inflicted' illnesses

* 114,000 of the 12 million smokers in the UK die each year as a result of their habit.

* 20% of adults in the UK are obese, and one in four children are overweight, making Britain the fattest country in Europe.

* 8,386 people died from drink-related illness in the UK in 2005. Rates have nearly doubled for 35 to 54-year-olds since 1991.