Continued unhealthy lifestyles in the UK means that the NHS will in the future have no choice other than to pare back some treatment that is currently free, experts have warned.

While government campaigns to persuade individuals to live healthier lifestyles have failed, legislation to curb smoking has been hugely successful; therefore, penalties are also a likely solution to help relieve the current strain that unhealthy behaviour places on the NHS, according to Visions of Britain 2020, the third in a series of reports produced by insurer Friends Provident and the Future Foundation think tank.

As well as penalties, experts consulted for the report predict that a range of treatments will no longer be free in 2020, including: IVF and fertility treatment; subsidised dental treatment; obesity surgery and drugs; dementia treatment; and complementary therapies.

“That the NHS will be reduced in terms of scope is almost inevitable,” the report forecasts.

“There will be less and less money coming from the state to help people maintain their health, so something needs to give, and increasingly it will be up to us to take responsibility for our own health,” said Dr Patricia Macnair, a medical practitioner consulted for the report. “In addition, there will be endless paring away in subtle degrees at the funding for all sorts of different treatments - although this may be subtle, the changes will be profound," she added.

Health care writer Dr Sarah Brewer agrees that “something has to give. One scenario is that people may well end up being charged for certain treatments or denied certain non-essential treatment, particularly if their unhealthy lifestyle was a contributory factor. The other scenario is the withdrawal of many free treatments,” she says.

Experts and consumers questioned for the study agree that unhealthy lifestyles should be penalised when it comes to treatment, with 44% supporting the introduction of a “fat tax” and 38% agreeing that that NHS should not prioritise people who fail to look after their health.

But, despite this apparent support for penalties, we still readily admit that we are not leading healthy lifestyles. Just 18% and 19%, respectively, claim to be adhering to government guidelines on calorie intake and exercise, while 34% say they follow official guidelines on alcohol consumption. Experts claim this apparent ambivalence to today’s guidelines will force the government to take a new, prescriptive approach.

“A voluble New Puritan group will support these measures, something that will encourage legislators,” the report adds.

Trevor Matthews, chief executive officer of Friends Provident, said: “our report reveals that there will be a fundamental and permanent change in the provision of free healthcare in the next decade. The study identifies a disconnect between our aspirations for healthcare, and our behaviour. We all need to adopt healthier lifestyles or else risk being faced with penalties in the years ahead.”