'NHS should not treat those with unhealthy lifestyles' say Tories

Patients would be handed "NHS Health Miles Cards" allowing them to earn reward points for losing weight, giving up smoking, receiving immunisations or attending regular health screenings.

Like a supermarket loyalty card, the points could be redeemed as discounts on gym membership and fresh fruit and vegetables, or even give priority for other public services - such as jumping the queue for council housing.

But heavy smokers, the obese and binge drinkers who were a drain on the NHS could be denied some routine treatments such as hip replacements until they cleaned up their act.

Those who abused the system - by calling an ambulance when a trip to the GP would be sufficient, or telephoning out of hours with needless queries - could also be penalised.

The report calls for a greater emphasis on the "citizen's responsibility" to be healthy and says no one should expect taxpayers to fund their unhealthy lifestyles.

Yet while the Health Miles Card would award points for giving up smoking and losing weight, it could penalise those who are already fit and well because they would receive no benefits under the scheme.

Also, the NHS already demands that obese patients lose weight before receiving hip replacements.

And any moves to impose compulsory cards on patients would provoke a backlash from civil liberties groups.

The Dorrell report also calls for a consultation on raising the smoking age to 18 and for shops to be stripped of their licences if they sell tobacco and alcohol to minors.

It proposes a fully-trained nurse to be made available to every school to offer advice on sexual health - but Tory officials stressed they would not be offering children contraceptives.

Ministers should divert more attention and funding to public health epidemics which are costing the NHS billions a year, the report says.