Ministers are pressing ahead with proposals that will see NHS staff ask patients about their lifestyles during appointments, despite concerns that patients may resent such "intrusive" questioning.
The health secretary, Andrew Lansley, has decided to back the NHS Future Forum's controversial idea, which calls on midwives, surgeons and health visitors, as well as doctors and nurses, to ask patients about their smoking, drinking, diet and physical activity every time they see them.
The "make every contact count" plan, contained in the forum's latest report to ministers, has divided the medical profession. The British Medical Association endorsed the recommendation and said that dealing with lifestyle issues is already a key part of what GPs do when they see patients, when time allows.
But the Royal College of Nursing voiced doubts about the potential impact on relationships between NHS staff and patients, some of whom might be embarrassed by such questions or not tell the truth.
Lansley plans to oblige NHS staff to pursue such subjects with patients as part of an enhanced effort to reduce the soaring medical and financial cost of lifestyle diseases and to try to turn the NHS from a service that treats illness to one that does much more to prevent ill-health and promote healthy habits. He will enshrine the new obligation in the NHS constitution after consulting on how best to do it.
Doctors and nurses must "change how they use their time", the forum suggests, so they can take every opportunity to talk to patients about issues such as smoking, obesity and alcohol consumption. NHS staff, also including dentists, pharmacists and physiotherapists, are expected to do much more to improve patients' physical and mental health and wellbeing, and offer them advice and support to minimise or quit unhealthy habits.
The forum is a group of 57 experts chaired by the government's NHS trouble-shooter, Prof Steve Field, former chairman of the Royal College of GPs. Its report says: "There are millions of opportunities every day for the NHS to help to improve people's health and wellbeing and 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 checkup 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 checkup is an opportunity to talk over concerns about smoking, diet and physical activity."
Andy Burnham, the shadow health secretary, said: "This is an interesting idea in principle but the government needs to tread carefully if it is to avoid accusations of extending the 'nanny state'."
The forum also outlined plans to improve the health of the 1.4 million NHS staff in England and said the NHS should "put its own house in order" before suggesting lifestyle changes to patients.
