We need to discuss whether patients who are obese, smoke or drink too much should have the same entitlement to NHS treatment, a Liberal Democrat councillor says.

Cllr Stephen Giles-Medhurst – who has been receiving treatment for bladder cancer for the past 10 months – says most hospital patients would not hesitate to act on the advice of their doctors.

But the Hertfordshire county and Three Rivers district councillor says that during his own treatment he saw some patients refusing to even try to give-up cigarettes, on the advice of their doctor.

In one case, he says he heard a patient refuse, even though the doctor advised that continued smoking would mean he would lose his leg.

Cllr Giles-Medhurst says that with the National Health Service struggling financially, there needs to be “a conversation” about entitlement.

And he is questioning whether those who refuse to make lifestyle changes should be given the same priority – or whether they should even be charged for their treatment.

“I do wonder if you’re not going to change a lifestyle that’s causing the health issue should you really get free care?” he said.

“If I had been told I had bladder cancer and I had to stop drinking alcohol – there would be no question, I would not drink alcohol.

“If someone is told that something affects their health, why wouldn’t you say that at least you will try and give it up –  rather than a blank ‘no’.”

Cllr Giles-Medhurst accepts that there are some people who will have greater difficulty in giving-up cigarettes or alcohol or in reducing their weight.

And he is not calling for all those who smoke, drink or who are obese to be refused treatment. Nor is he saying that it should apply to patients who are terminally ill.

However he does say there needs to be “a conversation” about whether patients who refuse to make necessary lifestyle choices should be given the same priority to the same free NHS treatment.

At the very least, he says, people need to be encouraged to make those lifestyle changes, to help their health and the NHS.

And in some cases he questions whether – should they refuse to make the necessary lifestyle changes or try to – they should be asked for a financial contribution.

“I don’t have an answer – but it’s a conversation we need to have,” he said.