People who want access to the NHS should behave more responsibly, says expert

Patients should recognise they have to take responsibility for their own health if they want access to free healthcare, says a leading academic.

Durham University's Martyn Evans makes the comments as the Healthcare Commission publishes its 'State of Healthcare' annual report (10 December).

Professor Evans argues that patients should comply with ten moral duties, which require them to look after themselves and others around them, and to use the NHS in a responsible way.

People who neglect their health and the health of others around them, or who misuse the healthcare available to them are draining the NHS scarce resources, says the researcher.

Professor Evans, from Durham University's School of Medicine and Health, says:

"Widespread behaviour that is adverse to health and to the effectiveness of the NHS, such as binge drinking and missing GP appointments, is on the increase. There is clearly a need to state more clearly the responsibilities patients have to secure the future of the free public healthcare system.

"Right now, far too many people suppose that only doctors have duties, and that only patients have rights."

Professor Evans, who has published an academic paper on patient duties, suggests individual patients should cooperate more fully with medical advice and treatment, be courteous to NHS staff, and follow health promotion guidelines.

Professor Evans explains: "I believe the duties I propose would make the healthcare system work more effectively for the individual patient, could speed up recovery, and overall would increase the availability of the healthcare resources for other patients. These duties are the reasonable 'price' of accessing scarce NHS resources that are held for the common good.

"They could not of course be enforced and perhaps they should not all be, even if they could. However, recognising them would contribute to a vitally important 'culture shift' in the expectations that people have of the NHS."

In his paper, Professor Evans outlines ten moral duties. They recommend patients promote their own health both before and after illness, access healthcare in a responsible and truthful way, and in certain specific circumstances, take part in medical research.

Professor Evans comments: "The fact that falling ill is largely beyond the patient's control, and the fact that most people have no choice but to rely on publicly funded healthcare from the NHS, all give added strength to the argument. They emphasise our common need for the same scarce resources, and our shared responsibility to make sure those resources are used most effectively, to the benefit of all of us."

The ten moral duties

1. Duty to participate in a 'healthcare jurisdiction'
2. Duty to uphold his or her own health
3. Duty to protect the health of others
4. Duty to seek and access healthcare responsibly
5. Duty of truthfulness
6. Duty of compliance
7. Duty of inpatient conduct
8. Duty of recovery or maintenance
9. Duty of research participation
10. Duty of citizenship