Health Check: 'None of us is perfect, and I know I benefit from being reminded of what is in my best interest'

It was, I think, Virginia Bottomley, the fragrant former Tory health secretary, who a decade ago suggested we all might be better off if we ate three egg-sized potatoes a day. She was lambasted for her temerity in daring to suggest there was anything at fault with the nation's diet.

How delighted Mrs Bottomley must have felt seeing Labour discomfited last week by revelations that it plans to demand smokers, couch potatoes and overweight people sign agreements with their doctors to take more exercise or to eat a more nutritious diet in return for treatment.

The proposals are contained in a policy paper posted on the party's website which, contrary to the report in The Times which broke the story, explicitly rules out the idea that patients could be refused care if they did not comply.

"The idea [is] not to exclude patients from care but to remind them of the need to use the health service - a free and finite resource - responsibly," it says.

This inconvenient point - inconvenient for commentators eager for an opportunity to write some knocking copy - did not deter the press comment that followed the Times story.

Juliet Lawrence Wilson in The Mirror called it "cowardly" and "ridiculous". Stephen Pollard in The Times described it as a "grotesque example of the blinding stupidity of juice bar lefties." The Daily Star dismissed it as a "sick joke."

This kind of response actually makes me feel sorry for the policy wonks in Downing Street and Millbank who labour long into the night to come up with ideas that might just improve a few people's lives without losing their party the next election. With a simple twist of the truth - an omission that no one bothered to check against the original - the idea has been transformed into a ludicrous proposal that everyone can enjoy poking fun at. But that, alas, is the way we choose to conduct political debate.

Is there merit in the idea? Why, of course. It may be unfashionable to say so, but I am in favour of more nannying, not less. None of us is perfect and we benefit (I know I do) from being reminded of what is in our best interests. But don't just take my word for it. Here is Carol Cooper, The Sun's GP: "It is pathetic to suggest people may dig their heels in just because they are told to do something they don't like. Luckily, not everyone acts like a two-year-old child. Getting advice and following it is what we go to a doctor for."

Precisely. Labour's proposal does go beyond this in suggesting patients should reach an agreement with their GP to do their bit to improve their health. But this is not new either.

As Labour party spokespeople pointed out, but failed to get acknowledged (it would have spoilt the story), it is already the case that smokers who go to their GP for nicotine patches are required to sign up to a full smoking cessation programme. If they decline, they have to buy the patches over the counter for themselves.

But there is a key question Labour has to answer. One of the NHS's greatest strengths, which must be protected at all costs, is that it is non-judgmental, offering treatment without prejudice to drunks, injecting drug addicts, self harmers, smokers, fatties and all those who abuse themselves by whatever means they choose. If free care is to be offered to everybody, as it must be, however blithely irresponsible they are in regard to their own health, what sanction is to be applied to those people who breach Labour's proposed GP agreements?

On this point, the party is so far silent. That silence has been filled by speculation which has derailed the debate. But perhaps no sanction is necessary. We know that advice from the GP to a smoker to give up is the single most effective use of medical time - in terms of health gain for time, effort and money spent. In place of sanctions we should be thinking about incentives - for GPs to hand out the advice and for patients to follow it.