Published: 01/07/2004, Volume II3, No. 5912 Page 8

Imposing obligations on patients to use healthcare responsibly is gaining ground in government thinking, Professor Edward Peck of Birmingham University told the conference.The public health model of informing and encouraging behaviour change was not working and needed to be rethought, the director of the Health Service Management Centre said. 'This seems to be something that New Labour is prepared to take seriously, ' he said, pointing to the debate on public smoking moving from a paternalistic model to one of responsibility for others. Sanctions could include exclusion from school of children who have not been vaccinated, charges for patients who do not attend appointments and denial of care to people 'whose behaviour makes it futile'.

www. hsmc. bham. ac. uk/healthobligations.