NHS report advises talking routinely about diet, smoking and drinking even if the patient is suffering from an unrelated illness
Patients should be asked about their diet, smoking and drinking habits every time they see a health professional according to radical proposals from the government's NHS advisers to tackle soaring rates of obesity, cancer and alcohol misuse.
The NHS Future Forum wants health staff to routinely talk to patients about their lifestyles, even when they are suffering an unrelated illness, and offer them advice and help to become healthier.
The forum is urging a transformation in the relationship between medical staff and patients in order to reduce the toll of ill-health and the cost to the NHS caused by the sharply rising numbers of people with conditions linked to lifestyle.
Its call for a switch to a policy of "make every contact count" is the centrepiece of its forthcoming report on public health, commissioned by the health secretary, Andrew Lansley, which will be submitted to the Department of Health and published on 10 January.
Professor Steve Field, the coalition's NHS troubleshooter who heads the forum, said all healthcare professionals – not just doctors and nurses, but also midwives, physiotherapists and pharmacists – should pro-actively raise the issue of lifestyle every time they see patients.
But on Friday some medical leaders voiced fears that such interventions might stop some patients from seeking medical help in case they were asked questions they found uncomfortable, and the Patients Association said it was "overkill".
Field told the Guardian: "In future if you come for your flu vaccine at a GP's surgery or pharmacy, the health professional should give you your injection but also use the opportunity to talk to you about your diet, smoking, alcohol intake and how much exercise you're taking, discuss any anxieties you may have about these, and offer and advice and support. Similarly, a podiatrist who's looking after the feet of a diabetic patient has an absolute responsibility to talk to the patient about their smoking, because smoking makes diabetes worse and means the patient is more likely to have a foot amputated."
While raising personal behaviour was likely to prove a sensitive subject for staff, patients' trust in health professionals should ensure such conversations resulted in those who need it receiving help, he said. The damage to health and the spiralling cost to the NHS from what Field called "risky behaviour" is so alarming that staff must make "a cultural shift" in how they use their time with patients, he added.
Field acknowledged the controversial nature of the plan, which has been drawn up by forum members Ash Soni, a pharmacist, and Vicky Bailey, of the clinical commissioning group in Rushcliffe in Nottingham. "This is not the 'nanny state' at all," said Field.
"As a GP I know that people want help and support, but part of the problem is that people don't come forward for that help and support and, when they do, health professionals often miss the opportunity to make a positive change in their lifestyle. The NHS needs to change from patching people up when they are ill to promoting healthy living and preventing illness."
The forum consists of 57 advisers and has helped reshape the controversial NHS reform bill. Its report states: "Every healthcare professional should 'make every contact count'; use every contact with an individual to maintain or improve their mental and physical health and wellbeing where possible, in particular targeting the four main lifestyle risk factors: diet, physical activity, alcohol and tobacco – whatever their speciality or the purpose of the contact."
It adds: "There are millions of opportunities every day for the NHS to help to improve people's health and wellbeing and to reduce health inequalities, but to take this opportunity it needs a different view of how to use its contacts with the public. A routine dental check-up or eye-test, for example, is a chance to offer advice to help someone stop smoking.
"A visit from a midwife or health visitor is an opportunity to talk about a new parent's anxieties and consider options for accessing mental health support. Collecting medication from a pharmacy is a chance to offer someone help with cutting down on alcohol. A pre-surgery check-up is an opportunity to talk over concerns about smoking, diet and physical activity."
But Dr Clare Gerada, chair of the Royal College of GPs, said the policy was "muddled" and some patients might be put off by what they saw as intrusive questioning from visiting family doctors. "Young men pluck up the courage to go and see their GP, maybe about a sexually-transmitted infection, and would not want to be lectured by a middle-aged woman like me. So we have to be careful that we don't impose our agenda on to the patients and don't inadvertently frighten patients who are coming in to see the doctor and who fear that they might be preached at," said Gerada.
Dr Peter Carter, chief executive of the Royal College of Nursing, said that while no one could disagree with the "make every contact count" principle, a patient's tendency to conceal their alcohol or tobacco intake and refusal to discuss drinking because they do not think it is linked to their gastric problem, for example, could make such conversations difficult. A renewed use of awareness-raising campaigns would be more effective, Carter added.
Katherine Murphy, chief executive of the Patients Association, said it agreed that patients needed more advice on living more healthily and help to do so. "But the underlying factors causing unhealthy lifestyles, for example poverty, also need to be addressed.
If a patient is being treated for a condition unrelated to lifestyle choice they will want the clinicians to focus on that, rather than feeling obliged to sit through an examination of the way they choose to live. It seems like overkill to ask every clinician to inappropriately badger and lecture patients each time that they see them," Murphy added.
However, National Obesity Forum spokesman Tam Fry said health professionals' reluctance in recent years to tell parents their child was overweight had contributed to the rise in obesity. "We welcome this plea from the NHS Future Forum. It's a great beginning for 2012 that the medical profession is being advised to act in this way. It will do more good than harm. Health professionals have to change their mindset about approaching parents about their children's weight", he said.
A spokesperson for the health department said: "We will consider any initiatives put forward by the independent NHS Future Forum to improve public health. That's why we asked them to listen specifically on how the NHS could support people to live a healthier life, and we look forward to the publication of their report."