Sign of the times

LUDICROUS, impractical and patronising. That's how former health secretary Frank Dobson describes the latest Labour Party wheeze for getting us to take more responsibility for our health. The proposals, contained in a consultation paper that will be discussed at Labour's annual conference, would require some patients - smokers, drinkers and the overweight - to sign health 'contracts' with their GPs.

The patient would undertake to follow the doctor's advice on things such as lifestyle, diet and exercise, and to keep appointments: and the doctor to provide a certain standard of treatment.

Nobody understands better than the York-born former health secretary the need for some people to take better care of their health. But contracts, Mr Dobson sniffs, are not the answer. "It was probably thought up by a couple of barristers," he says. "Are we going to have to go to judicial review to see whether we can get cough mixture?"

Alan Maynard, York University health economist and the outspoken chairman of York Hospital, is almost equally scornful. "It is quite clear that we could achieve very significant health gains if we could alter people's behaviour and make it more healthy, if we could cut down smoking, increase exercise, alter diet and reduce alcohol consumption," he concedes.

"It is very important to try to make people aware of the risks of these unhealthy behaviours, and try to persuade them to change. There is an obligation on the part of health care providers, whoever they are, to try to identify all these behaviours and try to encourage people to change.

"But my belief is you cannot make them sign contracts because I don't believe they would be enforceable. What is a contract? Something legally enforceable? And if you had a contract with me and broke it, what am I going to do? Take you to court? Lock you up? Deny you health care? Or take you to Whip-ma-whop-ma-gate and throw tomatoes at you?"

A bit of a thumbs down from the experts, then. But what about the man in the street? We spoke to a drinker, a smoker, and a man who weighs slightly less than his fridge to seek their views.

Ian Donaghy, aka Big Ian from York party band Huge

"I don't drink and I don't smoke, I'm just massive," says the Huge vocalist. How massive? "I'm lighter than my fridge!"

Despite being on the heavy side, however, Ian insists he is fit and healthy. "I'm fat but I'm fit," he says. "I don't drink and I don't smoke, and my cholesterol is as low as it can be. I'm just sitting down to my tea now. Low fat pasta thing with chicken, can of diet coke and low fat chocolate dessert from M&S.

"I've been 33 years on this planet and I have never, ever needed anything from the health service. Nothing other than very minor prescriptions for throat infections. I never get to go into hospital. How many people in this country, aged 33, can say the same?"

Health credentials established, he turns his attention to the question of the day. "The health service is not a magic porridge pot of funds," he says. "So clearly you have got to perhaps ask people to take a bit of responsibility for their health. But in this country, our right is that we have our health service and that has got to continue, so that if there is anything wrong with any of the family, you know it is there when you need it. That's why you go to work and pay your taxes."

Jack Merry, landlord of York pubs the Tap and Spile and the Ackhorne

Being a publican, you'd expect Jack to enjoy the odd pint or two. And he does. Three or four pints a day on average, in fact. At least. That's a little more than the average man, he agrees.

He also agrees that he is overweight. "I'm portly, I'm diabetic and I've got high blood pressure," he says lugubriously.

He would like to take more care of his health, but never seems to find the time. "I think we all should look after our health more," he says. "That means eating properly, not necessarily dieting. But when I finish work at midnight, I will eat at 1.30 in the morning, which isn't good at all because it means I don't have any exercise to burn it off."

Even though he agrees that most people could do more to ensure they stay healthy, he says Labour's proposals are "disgusting".

"People should not be denied access to the NHS," he says. "We all contribute towards it, and if you are ill, you have the right to be treated."

Bob Cook, ex-smoker and one-time Army Sergeant-major, who runs the Adams House Hotel in Fulford

A year ago, Bob Cook's years as a heavy smoker were beginning to take their toll. He'd begun smoking in his teens and had been smoking ever since, apart from a few years when he managed to stop while in the army. As a 53-year-old he was still a 40-a-day man.

He knew had to quit, for his own health. His family has a history of heart disease. Both parents died of it, and one of his brothers also. He himself suffered angina that was so bad he was getting regular chest pains and could hardly walk without his special medication puffer.

He was desperate to give up, but it wasn't easy. Last summer, however, he signed up for his third 'stop smoking' clinic: and this time it stuck.

He thinks the secret was that before he began that third course, he gave up boozing as well. "Before, if I went out with the boys or down to the pub, I would smoke 20 cigarettes," he says. "When I stopped drinking, I reduced the number of cigarettes I was smoking by at least a third straight away."

The effect on his health of stubbing out his smoking habit has been dramatic. He's put on a bit of weight: but he's far fitter and healthier than a year ago. He cycles, works out at the gym three or four times a week, can walk without a hint of a wheeze, and doesn't need to use his puffer any more. "I feel brilliant!"

He made the effort to change his lifestyle. But even so, he thinks the idea of a patient contract which would force a patient to change their ways is absolutely wrong. "Every person is entitled to health treatment," he says. "I don't think it is down to a doctor to say I'm not treating you because you smoke.

"They can say you're putting your health at risk by smoking, but not that we're not going to treat you. That's what doctors are for."

u To find out about stop smoking clinics near you, call the North Yorkshire Stop Smoking Service on 01904 663310.LUDICROUS, impractical and patronising. That's how former health secretary Frank Dobson describes the latest Labour Party wheeze for getting us to take more responsibility for our health. The proposals, contained in a consultation paper that will be discussed at Labour's annual conference, would require some patients - smokers, drinkers and the overweight - to sign health 'contracts' with their GPs.

The patient would undertake to follow the doctor's advice on things such as lifestyle, diet and exercise, and to keep appointments: and the doctor to provide a certain standard of treatment.

Nobody understands better than the York-born former health secretary the need for some people to take better care of their health. But contracts, Mr Dobson sniffs, are not the answer. "It was probably thought up by a couple of barristers," he says. "Are we going to have to go to judicial review to see whether we can get cough mixture?"

Alan Maynard, York University health economist and the outspoken chairman of York Hospital, is almost equally scornful. "It is quite clear that we could achieve very significant health gains if we could alter people's behaviour and make it more healthy, if we could cut down smoking, increase exercise, alter diet and reduce alcohol consumption," he concedes.

"It is very important to try to make people aware of the risks of these unhealthy behaviours, and try to persuade them to change. There is an obligation on the part of health care providers, whoever they are, to try to identify all these behaviours and try to encourage people to change.

"But my belief is you cannot make them sign contracts because I don't believe they would be enforceable. What is a contract? Something legally enforceable? And if you had a contract with me and broke it, what am I going to do? Take you to court? Lock you up? Deny you health care? Or take you to Whip-ma-whop-ma-gate and throw tomatoes at you?"

A bit of a thumbs down from the experts, then. But what about the man in the street? We spoke to a drinker, a smoker, and a man who weighs slightly less than his fridge to seek their views.

Ian Donaghy, aka Big Ian from York party band Huge

"I don't drink and I don't smoke, I'm just massive," says the Huge vocalist. How massive? "I'm lighter than my fridge!"

Despite being on the heavy side, however, Ian insists he is fit and healthy. "I'm fat but I'm fit," he says. "I don't drink and I don't smoke, and my cholesterol is as low as it can be. I'm just sitting down to my tea now. Low fat pasta thing with chicken, can of diet coke and low fat chocolate dessert from M&S.

"I've been 33 years on this planet and I have never, ever needed anything from the health service. Nothing other than very minor prescriptions for throat infections. I never get to go into hospital. How many people in this country, aged 33, can say the same?"

Health credentials established, he turns his attention to the question of the day. "The health service is not a magic porridge pot of funds," he says. "So clearly you have got to perhaps ask people to take a bit of responsibility for their health. But in this country, our right is that we have our health service and that has got to continue, so that if there is anything wrong with any of the family, you know it is there when you need it. That's why you go to work and pay your taxes."

Jack Merry, landlord of York pubs the Tap and Spile and the Ackhorne

Being a publican, you'd expect Jack to enjoy the odd pint or two. And he does. Three or four pints a day on average, in fact. At least. That's a little more than the average man, he agrees.

He also agrees that he is overweight. "I'm portly, I'm diabetic and I've got high blood pressure," he says lugubriously.

He would like to take more care of his health, but never seems to find the time. "I think we all should look after our health more," he says. "That means eating properly, not necessarily dieting. But when I finish work at midnight, I will eat at 1.30 in the morning, which isn't good at all because it means I don't have any exercise to burn it off."

Even though he agrees that most people could do more to ensure they stay healthy, he says Labour's proposals are "disgusting".

"People should not be denied access to the NHS," he says. "We all contribute towards it, and if you are ill, you have the right to be treated."

Bob Cook, ex-smoker and one-time Army Sergeant-major, who runs the Adams House Hotel in Fulford

A year ago, Bob Cook's years as a heavy smoker were beginning to take their toll. He'd begun smoking in his teens and had been smoking ever since, apart from a few years when he managed to stop while in the army. As a 53-year-old he was still a 40-a-day man.

He knew had to quit, for his own health. His family has a history of heart disease. Both parents died of it, and one of his brothers also. He himself suffered angina that was so bad he was getting regular chest pains and could hardly walk without his special medication puffer.

He was desperate to give up, but it wasn't easy. Last summer, however, he signed up for his third 'stop smoking' clinic: and this time it stuck.

He thinks the secret was that before he began that third course, he gave up boozing as well. "Before, if I went out with the boys or down to the pub, I would smoke 20 cigarettes," he says. "When I stopped drinking, I reduced the number of cigarettes I was smoking by at least a third straight away."

The effect on his health of stubbing out his smoking habit has been dramatic. He's put on a bit of weight: but he's far fitter and healthier than a year ago. He cycles, works out at the gym three or four times a week, can walk without a hint of a wheeze, and doesn't need to use his puffer any more. "I feel brilliant!"

He made the effort to change his lifestyle. But even so, he thinks the idea of a patient contract which would force a patient to change their ways is absolutely wrong. "Every person is entitled to health treatment," he says. "I don't think it is down to a doctor to say I'm not treating you because you smoke.

"They can say you're putting your health at risk by smoking, but not that we're not going to treat you. That's what doctors are for."

To find out about stop smoking clinics near you, call the North Yorkshire Stop Smoking Service on 01904 663310.

Updated: 09:01 Monday, June 09, 2003