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NHS "should charge unhealthy patients"

Patients who do not look after themselves properly should be charged money to receive NHS care, according to a report.

Insurance group, Friends Provident, and the Future Foundation think tank surveyed 1,000 people to compile their Visions Of Britain 2020 report. It forecasts the consequences of people continuing to have bad diets and not taking enough exercise, concluding that they should be penalised if they are deemed unwilling to change their lifestyles.

Specialists consulted by the researchers said they believed medical provision, such as treatment for dementia or bad teeth, medication for obesity and fertility treatment, as well as complementary therapies, will be charged to patients in the future.

The survey suggested that Suffolk residents live the most unhealthy lifestyles out of 10 UK regions. They were apparently the most likely to ignore the amount of calories they consumed and recommended alcohol intake.

Sarah Brewer, a doctor and medical journalist who was asked her opinion by the report authors, said: "We all know that we should follow a healthy low-fat diet, eat at least five (portions of fruit and vegetables) a day, etc. But how many actually do anything about it?"

She insisted: "Unless an unhealthy diet and lifestyle is penalised in some way no one will change."

Copyright © Press Association 2010

Visions Of Britain 2020

Your comments (terms and conditions apply):

"I fully disagree. If the NHS wants extra charges why do they accept NI contributions from us who are overweight or with disabled children under enormous stress? I work and look after my 24 year old autistic son free of charge so I bring substantial money to the country and pay £500 a month NI together with my husband but severely criticised by my surgery due to smoke and overweight. Is that fair? If they were doing caring for 24 years I am wondering how much they would weigh and smoke?" - Edith Simon, Cambridge

"No, but maybe some areas of complementary therapies should be chargeable. I don't understand why some
people seem to get a big chunk of NHS funding for spurious blood tests, counselling (for 'mild' causes - not assault, bereavement etc), countless ear syringes (which are fast becoming a 6 monthly cosmetic procedure where I practice), regular GP appointments for extremely minor aches and pains, and any amount of middle-class hypochondria and selfish reasons; when the poor and disaffected have their services cut completely. We have a number of very unpleasant, demanding, well-off people who could well pay for unnecessary procedures, including one woman who goes home to south Africa to see her 'therapist' and then comes to the UK with a list of demands for expensive bloods tests and other investigations to be paid for by the NHS! Maybe charging non-UK nationals for everything other than emergency treatment is a better way, as we have to pay whenever we go abroad. Cutting down on health tourism would be a start, not cutting essential services like dementia care or rehab. Whilst we do little to stop children becoming hooked on drink and drugs in the playground we are duty bound to help them when they are a little older and on a downward spiral, thus costing the tax payer even more. And why pay for dementia?" - Name and address supplied

"No I don't agree people should be charged. In my experience as a nurse healthy people who have eaten a balanced diet, watched their weight etc also become ill with diseases such as cancer etc as not all diseases are linked to diet and weight others are genetically or hereditary linked. Whatever happened to compassion and caring for the sick, or should we charge all patients regardless? However, one positive step that could be
developed further is the use of exercise prescriptions" - Louise Baker, Midlands

"NHS is part of the free fringe benefits for all in society. Refusing treatment to a group of people for reason - obese, addiction, would be unfair. As these group of people come in to the hospital and would demand to be treated because it is their right. Therefore, I think its unfair to charge them. It's the right thing, so let's get on with it. Free treatment for all" - Obiageri  Uwakwe, Leeds

"What is happening to the NHS? The main principles were made clear: the health service will be available to all and financed entirely from taxation, which means that people pay into it according to their means. But here we are being judgemental and putting down the individuals who probably need the NHS more than anyone. Shouldn't we be helping them and not penalising or dictating to these individuals? It will be suggested that my comments are naive and maybe they are, but surely its about the patient and treating them in a holistic way and this must take into account their bad habits as well as their good. The NHS should not be charging just because you don't like the way someone lives their lives.
Finally, to heat up the discussion, I was wondering if Sarah from Hampshire is a nurse; if so maybe she should consider a change of career to something like a debt collector or traffic warden because I failed to see any compassion in her statement" - Phil, Wales

"I agree to a certain degree; however, not all obese people are obese by choice for some certain medications have greatly contributed to their obesity. I have to ask if someone is critically ill who is actually going to refuse to treat them I know I couldn't" - Alison, Glasgow

"Absolutely not ... all of us (since the inception of the NHS in 1948) have paid up front for the privilege of a 'free at the point of delivery' service and our parents fought for the service, it is inexcusable for people who should know better to even suggest charging the unfortunate members of society. Our 'gym bunnies' will eventually need the service. I hope it's there when they do" - P Amis, Newcastle upon Tyne

"I think that it is very sad that we have come to this. The NHS was set up to help people from all walks of life, especially the poor and needy who may be the more unhealthy part of society. We also need to look at the many obese nurses who care for such people" - Michele Beevers, Birmingham

"At least those heavy smokers and drinkers should be charged for smoking/drinking related diseases" - Ray, Lothian

"Yes, I agree with it. The amount of obese, drug-taking, chain-smoking patients that are admitted to our ward is unbelievable. Something has to be done, but my poor mam developed dementia at a young age, how can that be compared with abusing your health? My mother never smoked, took drugs, eat healthy and exercised regularly, and developed dementia at 59" - Angela, South-east Wales

"Surely this would lead to nurses and doctors being charged, as many are heavy smokers and enjoy fast food and fizzy drinks alongside the unhealthiest of patients? When did the NHS start treating 'healthy patients' only? If this was the case most of us would be out of a job due to lack of patients!!!" - Lesley Hutton, Ireland

"No. Just no. I can't even think of the right words to express what a totally insane and unworkable idea this is. BTW 'gym bunnies' get LOADS of injuries/disease/OCD etc. Madness in the extreme. Its fascism..." - Isobel Yeomans, Nottingham

"I think this is a good idea, after all we get charged for not looking after our cars (ie, bald tyres) so why should it be different for ourselves? You don't need to join a gym to be fit, walking, cycling, and taking the stairs are every day activities people can do for free. However I do believe that central government needs to take greater responsibility, and break their strong alliance with the food industry" - AW, Avon

"Where do you draw the line and what criteria would be used? I have nursed for over 30 years and seen all kinds of extremes, I know one person who is officially obese but teaches and practices Latin American dancing. She is very fit, but the other extreme is a person who after being injured, unable to work or exercise gains 3 stone. Who decides who should pay? The other extreme this government can initiate is compulsory euthanasia at retirement age or when not able to function" -  Theresa Mulroy, Manchester

"It is well known that this thinking in the hands of poorly processed systems will be open to discriminating unreasonably against those who are deemed living unhealthy lifestyles. Why not keep care individualised and have a multi-peopled team to assist in managing those patients who are CONSISTENT violators of their own health and well being, and create a
charging system for them till they comply" - Sharron, London

"I think this topic is too broad and I would like the authors to first categorise what they deem self-neglect. So many people will fall into different groups, eg, genetic diseases. Who will be responsible for deciding whether someone is neglecting their health or not? How do you do that. I can't help thinking that this is one of those not so well thought ideas and is typical of these think tanks at the moment. However, as a nurse myself, I have seen patients who have been given a second chance in
life with liver transplant but then again, they went back to abusing alcohol again. Thorough assessments followed and they had a mental health illness. This is too grey an area to try and temper with at the moment so I can say, as long as we prioritise patient's choice within the NHS, then everyone should be treated the same" - Tinashe, Luton

"If we were to be charged it would cost me and my husband as we are both overweight. However, we do eat a sensible diet and garden and have a dog which requires 'walkies'. My patients have often said that they can talk to me because I am not a size 0 and that I appreciate the problems they have. All smokers know they should stop all fat people know they should be thin, if only it was that easy!" - Ruth Wright, Kent

"No certainly not. It would be difficult not to find a reason to charge anyone wanting healthcare. The lady and gentleman who attend the gym five days a week might injure themselves, would they expect to pay for treatment? Joggers might trip on the pavement anyone taking part in a sport can get injured. It would be their fault for taking part. This is another form of privatisation" - Linda, Somerset

"This is a very difficult one to deal with. I too go to the gym and eat a vegetarian diet, do not smoke and one day something will get me. One of our friends who is a cyclist, vegetarian and fitness queen has just been diagnosed with breast cancer and out of all of us she would be seen as the least likely person. It would be good to educate some families who clearly do not know what good looks like but would need to be done with great sensitivity. Continuing to drink and smoke despite poor health is madness and it places pressure on the limited NHS and the day will come when action will be taken" - Kathy, London

"What arrogant posturing. NHS patients are free beings born into a despotic, tyrannical monopoly. Once, after being 'diagnosed' with high cholesterol levels, I was told by a fat, young receptionist that I would have to change my lifestyle.  My mother who had a lean diet had screamingly high levels. It is genetic. Abolish the NHS and its non-accountable employees" - Lois Crofton, Leicestershire

"To a certain degree I would agree with charging patients that cannot (or will not) take responsibility for their own health. But I'm wondering if this would open a can of worms. Should we charge contact lens wearers when they develop bacterial keratitis because they've overused their lenses? Should we charge people who have an accident whilst practising an extreme sport? Obese people who develop diabetes? Smokers that develop cancer? Self-harm/suicide attempts? The possibilities are endless!" - Trevor Guilliano, Gibraltar

"Yes absolutely. Myself and my husband are very keen gym bunnies, (5 times a week), we watch what we eat, we don't smoke or drink. Why should we have to wait for FREE NHS treatment besides those that are obese, use drugs, and or smoke and do not look after themselves? Maybe the thought of digging in their pockets will make these people finally change their ways!! This is fantastic news, I wholeheartedly support this proposal" - Sarah, Hampshire

"No way. It is impossible to prove and, therefore, to implement. It penalises those on low incomes, and especially pensioners who cannot afford five portions of fruit and veg per day and may be unable to exercise because of other disabilities" - JA Holland, Wiltshire