Soon you'll have to deserve your healthcare

I've gone off the prime minister. It began when his 'government of all the talents' failed to include either Conservatives or GPs. (He obviously has a selective definition of the word 'all'.)

Now he has suggested that, instead of the NHS being free to all (same word), those who smoke or are obese may be refused access to its services.

I wonder if he has thought through the practicalities? Who now will be truthful about their smoking habits, knowing that access to care may depend upon the answer?

Does his objection to obesity include those with hypothyroidism, eating disorders or psychological problems? What about members of the British Lions rugby team, whose high BMIs are from muscle, not fat?

If politicians are to exclude self-inflicted conditions, what about those who suffer sports injuries, STIs or alcohol problems?

Once politicians start to make value judgments about individuals' entitlement to healthcare they are on a slippery slope.

Gordon Brown wants citizens to treat the NHS responsibly. Yet, ironically, patients who want to look after themselves more carefully by purchasing anti-cancer medication not funded by the NHS are excluded from all NHS cancer treatment.

In the future, will some find that, despite having paid their taxes, they are refused access to their own NHS? Will there be a tax refund for those denied treatment? And what happens to those whom the NHS won't treat? It is often the poor and disadvantaged who smoke and are obese.

For politicians to suggest that the taxpayers' NHS should be barred to those who don't conform to what they approve of beggars belief. Questions would be asked in parliament were a private insurance company to behave like this - receiving contributions then retrospectively limiting benefits.

But we shouldn't be shocked. This is another example of the government's high-handed approach to 'fixed and binding' NHS contracts which it then feels free to break unilaterally - the GP contracts being typical. Mr Brown's announcement should come as no surprise: it is the natural response of a government which thinks it has a monopoly on truth and a divine right to tell everyone else where to get off.

Dr Lancelot is a GP from Lancashire. Email him at

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