'Stay slim if you want a new hip'

Patients may only be offered a hip replacement on the Health Service if they promise to stay slim, under plans for social contracts' being considered by Tony Blair.

And parents could be made to sign pledges detailing what they must do at home to help their child's education.

The idea of introducing contracts between state and citizen is one of a number of proposals being looked at by the Downing Street policy review, established by the Prime Minister a month ago.

The documents would set out what individuals must do in return for receiving high-quality public services.

Papers released by the Cabinet Office yesterday reveal that six policy groups have been set up to look at issues ranging from the economy to crime.

The review is asking: Should we be aiming for a more explicit statement of the contract that covers both the service offered by the public sector (what is in and what is not) and what is expected from citizens (beyond paying taxes and obeying the law)?

Could we move from an implicit one-way contract based on outputs to one based on explicit mutually-agreed outcomes – how might this work in key areas like healthcare, schooling, policing and family support?'

Mr Blair's move to set up the policy groups is being seen as an attempt to secure his legacy before leaving Downing Street.

The process is expected to inform the Budget and Comprehensive Spending Review, which will set Whitehall budgets for the coming three years.

A No 10 spokesman said: One of the issues the groups have been asked to look at is a contract between citizen and state and how far that can be developed. No specific proposals have been agreed.'