Socialized medicine leads to dictatorship over your personal life

The endpoint of all socialism -- as Hegel gleefully foresaw

Patients could be required to stop smoking, take exercise or lose weight before they can be treated on the National Health Service, Gordon Brown has suggested. In a New Year message to NHS staff, the Prime Minister indicates people may have to fulfil new "responsibilities" in order to establish their entitlement to care. The new conditions could be set out in a formal NHS "constitution", Mr Brown says.

In his open letter to doctors, nurses and other health workers, the Prime Minister promises to press on with Tony Blair's reforms of the NHS, pledging more personalised care for all patients. He adds: "We will also examine how all these 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."

Creating formal conditions for treatment would build on recent controversial developments in health policy. Despite the NHS commitment to provide free universal care, it is already common for doctors to set conditions on patients seeking treatment. The National Institute for Health and Clinical Excellence already considers so-called self-induced illnesses in setting the criteria that determine which patients should qualify for new or expensive health treatments. And this year Leicester City Primary Care Trust was given Government approval to ask smokers to quit before they are given places on waiting lists for operations such as hip replacements and heart surgery.

Obese people also face more conditions from doctors who say being very overweight unnecessarily complicates many procedures. For example, fertility doctors have argued that very obese women should be denied access to IVF treatment.

Mr Brown has promised more "personalised" services from the NHS. He makes clear that his reforms will rest on people being more accountable for their own health, too. "We will describe how we will achieve our shared ambition of an NHS which is more personal and responsive to individual needs," the Prime Minister writes. "Personalised not just because patients can get the treatment that they need when and where they want, but because from an early stage we are all given the information and advice to take greater responsibility for our own health."

Katherine Murphy, a spokesman for the Patients Association, raised fears about the spread of conditions in the NHS. She said: "We would have concerns about this. Patients do have a right to access to care and we would be very concerned if people were to be denied access to care. "Is this being done for the patient, or is it just another way of saving money?"

Since becoming Prime Minister, critics say Mr Brown has sent mixed messages about his plans for NHS reform. But Mr Brown makes clear the NHS must change to respond more quickly and directly to the wishes and needs of its patients, just as businesses respond to their customers. "I believe these are steps vital to securing the health of the NHS for the next 60 years," Mr Brown says. "They will require a broadening and a deepening of reform to ensure that the NHS as a whole attaches the same priority to a personal and -preventative service as many of you already reflect in your own day-to-day decisions."

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