Smokers and obese people to be denied routine surgery on the NHS in Devon

ceadaoin.

The NHS in Devon has said that smokers and people classified as morbidly obese will not be allowed surgical procedures until they have quit smoking or lost 5% of their total weight.

I know that if you are obese there is a higher risk of complications during surgery so I suppose that makes sense. I wasn't aware of any similar risk with smokers though.

What do people think about this? Discrimination? Sensible? I'm not sure. They might as well extend it to any unhealthy lifestyle choices such as heavy drinking if they are going to target smokers.

Also, I'm shocked that to save money they will only give people one hearing aid instead of two!

Smokers and the morbidly obese in Devon will be denied routine surgery unless they quit smoking or lose weight.

Patients with a BMI of 35 or above will have to shed 5% of their weight while smokers will have to quit eight weeks before surgery.

The NHS in Devon has a £14.5m deficit and says the cuts are needed to help it meet waiting list targets.

The measures were announced the same day government announced an extra £2bn of annual NHS funding.

It announced a range of cost-cutting measures on Wednesday including only providing one hearing aid, instead of the normal two, to people with hearing loss.

Shoulder surgery will also be restricted.

http://www.bbc.com/news/uk-england-devon-30318546

Montroseee

Obesity is far too tolerated in modern society, we are failing our future generations by letting it become acceptable. This can only be a good thing.

Did they ever? When I was in a hospital up North for elective surgery the nurse boosted my height so that my BMI was just under 35 as they wouldn't have done the surgery if it was above 35.

At the same time though the other cuts are a bit more noteworthy. The Brits are really going to regret the selling-off of the NHS that's currently happening.

uch

That's me Double ballsed so

Ashbx

Absolutely ridiculous in my opinion! Like the OP said, we should also take into consideration peoples unhealthy lifestyles if smokers and obese people are targeted.

I cannot believe what I am reading in that article to be honest! I cant believe they are even allowed do that!

LenaClaire

ceadaoin. wrote: »

I wasn't aware of any similar risk with smokers though.




http://www.bbc.com/news/uk-england-devon-30318546

According to my friend who is an anesthesiologist, smokers tend to be much harder to sedate accurately and smoking also can have major implications on blood-flow and therefore healing.

SEPT 23 1989

Smokers,drinkers and obese people contribute a colossal amount of tax in their pursuit of fcuking themselves up

These health fascists should remember who pays their wages

the_syco

Obesity and smoking I can understand, as the smoking is probably to cover lung transplants, etc.

Can't fathom the one hearing aid thing, though. Just give them a cheaper hearing aid?

Pumpkinseeds

I'm expecting a follow up story stating that they're descriminating against patients and that it's a breach of their human rights or some such.:rolleyes: Basically I can't see it happening really.

Piliger

I don't believe these people should be denied treatment. But they should have the PAY THE FULL COST, up front.

Piliger

Piliger wrote: »

I don't believe these people should be denied treatment. But they should have the PAY THE FULL COST, up front.

They will have paid more than the full cost up front on the tax on the things that got them to the state they're in.

the_syco

Deleted User wrote: »

They will have paid more than the full cost up front on the tax on the things that got them to the state they're in.

Should we deduct their welfare checks? :pac:

ceadaoin.

Piliger wrote: »

I don't believe these people should be denied treatment. But they should have the PAY THE FULL COST, up front.

Well that would essentially be denying them treatment as most people wouldn't be able to afford to pay thousands of pounds upfront.

Where do you draw the line? If someone was drunk driving or speeding and was in a car crash, should they have to pay for their treatment too? It would be their own fault after all. That's not really what a healthcare system is supposed to be about.

Micky Dolenz

I read somewhere a while back that smokers cost X amount to the NHS but the taxes brought in are multiplies of X.

Smoking and being grossly fat are really stupid things though but I am sure there are better ways of combating it then scare tactics.

MarkAnthony

Deleted User wrote: »

They will have paid more than the full cost up front on the tax on the things that got them to the state they're in.

Micky Dolenz wrote: »

I read somewhere a while back that smokers cost X amount to the NHS but the taxes brought in are multiplies of X.

Smoking and being grossly fat are really stupid things though but I am sure there are better ways of combating it then scare tactics.

Its not as clear cut as that, there are indirect costs which in all honesty can be spun either way.

Frankly I think it's perfectly acceptable to get people to prepare for surgery, if you can lay off the burgers for 8 weeks or quit smoking in the run up to surgery you've bigger issues.

Dr Nic

Delighted. Alcoholics should also be in there. The idea of giving one of them a new liver that a kid with cf could have sickens me.

Caliden

Micky Dolenz wrote: »

I read somewhere a while back that smokers cost X amount to the NHS but the taxes brought in are multiplies of X.

Smoking and being grossly fat are really stupid things though but I am sure there are better ways of combating it then scare tactics.

Until smokers start costing more than their taxes bring in, smoking will remain legal.

seamus

Piliger wrote: »

I don't believe these people should be denied treatment.

The key thing here is that it's routine surgery; surgery which may improve one's quality of life and/or improve their length of life, but which is not immediately necessary to save their lives.

So hip surgeries, knee surgeries, etc. Life-saving surgeries aren't subject to the same restrictions.

This primarily comes down to costs; smokers and the obese have more expensive and complicated surgeries and poorer outcomes than normal-sized non-smokers. Everything about the operation, from the pre-treatment, to the surgery itself, to the recovery, consumes multiples of the resources of a normal person.

So on the face of it, it seems like a perfectly reasonable thing to do. They're not asking people to become super fit healthy before surgery, just show they're willing and capable to change their lifestyle and thus become less of a burden on the health system.

I'm not sure about alcoholics. I think on the whole they tend to die younger, and older alcoholics tend to be slimmer and not have many surgical complications.

MarkAnthony

MarkAnthony wrote: »

Its not as clear cut as that, there are indirect costs which in all honesty can be spun either way.

It's fairly clear-cut really. Add in the average 20 years of state pension not paid to smokers and it's even more clear-cut.

Frankly I think it's perfectly acceptable to get people to prepare for surgery, if you can lay off the burgers for 8 weeks or quit smoking in the run up to surgery you've bigger issues.

If it's stuff that'll make a difference. An abstract goal of 5% weight loss in 2 months (possibly through unhealthy methods) doesn't strike me as a great way to prepare for surgery. Healthy methods aren't exactly enforceable for that period of time either.

BlatentCheek

I fully agree with it. My understanding is that it's based on sound medical reasoning that the efficacy of the operations may be undermined by the patient being obese or a smoker so they won't risk wasting the resources if the patient doesn't make some effort towards making the operation a success. The patient is still free to tuck into a snackbox and light up as soon as they leave the hospital.
It seems proportionate and fair and I expect such health economics to feature more and more in modern healthcare as we try to deal with ever-rising health costs, an aging population and an obesity epidemic.

MarkAnthony

Dr Nic wrote: »

Delighted. Alcoholics should also be in there. The idea of giving one of them a new liver that a kid with cf could have sickens me.

A panel assess whether someone is suitable for transplant so you can stop being sickened.

seamus

seamus wrote: »

The key thing here is that it's routine surgery; surgery which may improve one's quality of life and/or improve their length of life, but which is not immediately necessary to save their lives.

So hip surgeries, knee surgeries, etc. Life-saving surgeries aren't subject to the same restrictions.

This primarily comes down to costs; smokers and the obese have more expensive and complicated surgeries and poorer outcomes than normal-sized non-smokers. Everything about the operation, from the pre-treatment, to the surgery itself, to the recovery, consumes multiples of the resources of a normal person.

So on the face of it, it seems like a perfectly reasonable thing to do. They're not asking people to become super fit healthy before surgery, just show they're willing and capable to change their lifestyle and thus become less of a burden on the health system.

I'm not sure about alcoholics. I think on the whole they tend to die younger, and older alcoholics tend to be slimmer and not have many surgical complications.

Then there's the difference the surgery could make. For more than 10 years the "cheap option" was taken with something I had wrong with me which led to me being on antibiotics many times, has left me hospitalised and still causes breathing problems, sleep problems and some of the secondary things have been linked to everything from lethargy to depression which doesn't exactly make it easy to then make a positive change. A simple surgery (in and out in the same day) 10 years ago and that would've been it.

MarkAnthony

Deleted User wrote: »

It's fairly clear-cut really. Add in the average 20 years of state pension not paid to smokers and it's even more clear-cut.

Spin it anyway you like, as I said there's evidence both ways. It is however not clear cut and anyone claiming it is doesn't know what they're on about.

Deleted User wrote: »

If it's stuff that'll make a difference. An abstract goal of 5% weight loss in 2 months (possibly through unhealthy methods) doesn't strike me as a great way to prepare for surgery. Healthy methods aren't exactly enforceable for that period of time either.

I'm sure The Devon NHS trust has a doctor or two employed with them, perhaps even an accountant.

darkpagandeath

Pretty sure refusing medical care is illegal and against the Hippocratic oath, not saying obese people should be tolerated as normal.

MarkAnthony

MarkAnthony wrote: »

Spin it anyway you like, as I said there's evidence both ways. It is however not clear cut and anyone claiming it is doesn't know what they're on about.

Of course a clear answer can never be right.

I'm sure The Devon NHS trust has a doctor or two employed with them, perhaps even an accountant.

That's how they got into the massive hole they're in now then? Good job.

MarkAnthony

Deleted User wrote: »

Of course a clear answer can never be right.


That's how they got into the massive hole they're in now then? Good job.

Probably a few smokers on the board.

seamus

darkpagandeath wrote: »

Pretty sure refusing medical care is illegal and against the Hippocratic oath, not saying obese people should be tolerated as normal.

The Hippocratic Oath doesn't really exist any more, it was formally adopted as the Declaration of Geneva. That said, it's not legally binding.

Refusing medical care is not illegal in absolute terms. The primary test is whether the doctor acted in the patients' best interests.

In this particular case, there are mountains of evidence which tell us that a patient who quits smoking or loses weigh in advance of surgery will have a much better experience. Therefore refusing treatment until they do these things, is in fact acting in the patient's best interests.

Shenshen

BlatentCheek wrote: »

I fully agree with it. My understanding is that it's based on sound medical reasoning that the efficacy of the operations may be undermined by the patient being obese or a smoker so they won't risk wasting the resources if the patient doesn't make some effort towards making the operation a success. The patient is still free to tuck into a snackbox and light up as soon as they leave the hospital.
It seems proportionate and fair and I expect such health economics to feature more and more in modern healthcare as we try to deal with ever-rising health costs, an aging population and an obesity epidemic.

Then why put a random figure like 5% weight loss in place?
Someone who is just above a BMI of 35 might drop under that magic figure by losing 5%, fair enough. Yet some with a BMI of 40 will still be morbidly obese even after losing 5% of weight. So medically speaking, what is being achieved there?

Other than having a convenient way of massaging the waiting list figures, obviously.

Tombi!

Is it really a bad thing?
It's not like they're denying surgery. It's "if you don't try to get healthy". I admit the 5% figure is sort of random and if you're about 10 stone overweight it's really not gonna matter that much.

MarkAnthony

Brutal Deluxe wrote: »

Is it really a bad thing?
It's not like they're denying surgery. It's "if you don't try to get healthy". I admit the 5% figure is sort of random and if you're about 10 stone overweight it's really not gonna matter that much.

There's some statistic ref 5% of body mass giving x health benefit. Can't remember it off hand. However in fairness a percentage figure is the fairest option especially given a time scale. It's not like smoking where one can simply stop.

ceadaoin.

MarkAnthony wrote: »

Its not as clear cut as that, there are indirect costs which in all honesty can be spun either way.

Frankly I think it's perfectly acceptable to get people to prepare for surgery, if you can lay off the burgers for 8 weeks or quit smoking in the run up to surgery you've bigger issues.

Some people might have mobility issues that prevent them from exercising or even moving so they might find it hard to lose weight. For some people it's not as simple as laying off the burgers.

I don't think anyone would have a problem with individual cases being assessed as too high risk for surgery. It's the fact that it is a blanket ban purely to save money rather than the decision being made on a case by case basis based on what is best for that patient.

Piliger

ceadaoin. wrote: »

Some people might have mobility issues that prevent them from exercising or even moving so they might find it hard to lose weight. For some people it's not as simple as laying off the burgers.

This is not the case. They are obese from eating. Stop eating and they will lose weight.

Piliger

darkpagandeath wrote: »

Pretty sure refusing medical care is illegal and against the Hippocratic oath, not saying obese people should be tolerated as normal.

No one is being denied medical care. Jut not major costly surgery.

MarkAnthony

ceadaoin. wrote: »

Some people might have mobility issues that prevent them from exercising or even moving so they might find it hard to lose weight. For some people it's not as simple as laying off the burgers.

I don't think anyone would have a problem with individual cases being assessed as too high risk for surgery. It's the fact that it is a blanket ban purely to save money rather than the decision being made on a case by case basis based on what is best for that patient.

Again IIRC there is some statistic that even with zero exercise 5% if loseable by diet change. Could be wrong on that simply trying to suggest a reason for the figure.

Being a fatty myself I know how easy it is to lose small percentages of weight, that isn't healthy in itself but when undergoing surgery might be beneficial.

ceadaoin.

Piliger wrote: »

This is not the case. They are obese from eating. Stop eating and they will lose weight.

Ok so if they can't exercise because they can't walk, and might be taking medications that cause them to gain weight they should just stop eating altogether?

Tombi!

MarkAnthony wrote: »

There's some statistic ref 5% of body mass giving x health benefit. Can't remember it off hand. However in fairness a percentage figure is the fairest option especially given a time scale. It's not like smoking where one can simply stop.

Oh, that's interesting actually.
I figure it could be based on a case by case basis. I mean the 30 stone man vs the 15 stone man would definitely have different amounts of weight to lose.

ceadaoin. wrote: »

Some people might have mobility issues that prevent them from exercising or even moving so they might find it hard to lose weight. For some people it's not as simple as laying off the burgers.

I don't think anyone would have a problem with individual cases being assessed as too high risk for surgery. It's the fact that it is a blanket ban purely to save money rather than the decision being made on a case by case basis based on what is best for that patient.

Weight loss is generally based on calories in vs calories out. You could be bedridden and still lose weight. A lot of programs on extremely obese people do show they have beyond terrible diets and consume far more.
Me drinking a small bottle of coke every day might not be best. But you have me drinking two liters of it a day and I'll put on weight.

Shenshen

MarkAnthony wrote: »

There's some statistic ref 5% of body mass giving x health benefit. Can't remember it off hand. However in fairness a percentage figure is the fairest option especially given a time scale. It's not like smoking where one can simply stop.

I'm no doctor, but just from personal experience, there would be no healthy way for someone weighing 100kg to lose 5kg in 2 months.
I've been working my way down the scales for the last 3 years now, and to achieve 1kg loss in one month, I'd be restricted to 1600 kcal a day. To lose more than twice that, you'd be down to around 1000 kcal. It'll take some very interesting food plan to convince me that that would be healthy.

Not to mention that the quickest way to gain weight is a crash diet like that - the yo-yo effect would very likely to pile all that back on again after the operation, and then some.

Tombi!

ceadaoin. wrote: »

Ok so if they can't exercise because they can't walk, and might be taking medications that cause them to gain weight they should just stop eating altogether?

You're suggesting a very, very small amount. There will always be exceptions. And, like the article said, exceptions can be made.

MarkAnthony

Shenshen wrote: »

I'm no doctor, but just from personal experience, there would be no healthy way for someone weighing 100kg to lose 5kg in 2 months.
I've been working my way down the scales for the last 3 years now, and to achieve 1kg loss in one month, I'd be restricted to 1600 kcal a day. To lose more than twice that, you'd be down to around 1000 kcal. It'll take some very interesting food plan to convince me that that would be healthy.

Not to mention that the quickest way to gain weight is a crash diet like that - the yo-yo effect would very likely to pile all that back on again after the operation, and then some.

Not a doctor either but I do know there is some debate over whether calorie control is the most effective weight loss tool, but I digress.

The fact remains that losing 5Kg in 2 months is probably ideal but then neither is being 100Kg. I think we'd need a doctor to tell us which is better. Going under the knife at 100Kg or losing the weight then undergoing the operation.

Tail Docker

Awful to hear. Happily, the only thing I want to have to do with Devon is eat some of their creamy rice pudding. They can jam their hospitals and their dumb policy up their buttery hoop. They never were the brightest anyway.

MarkAnthony

Brutal Deluxe wrote: »

Oh, that's interesting actually.
I figure it could be based on a case by case basis. I mean the 30 stone man vs the 15 stone man would definitely have different amounts of weight to lose.

Just did a quick Google there - various results from medical publications saying a 5-10% loss gives significant results in X and Y. As I say something I'd definitely heard in the past.

MarkAnthony

MarkAnthony wrote: »

Just did a quick Google there - various results from medical publications saying a 5-10% loss gives significant results in X and Y. As I say something I'd definitely heard in the past.

For the morbidly obese or the overweight? What timeframe?

Shenshen

MarkAnthony wrote: »

Not a doctor either but I do know there is some debate over whether calorie control is the most effective weight loss tool, but I digress.

The fact remains that losing 5Kg in 2 months is probably ideal but then neither is being 100Kg. I think we'd need a doctor to tell us which is better. Going under the knife at 100Kg or losing the weight then undergoing the operation.

It isn't for me, I find exercise much more efficient. But I may be the exception to the rule, as most of AH's qualified and accredited dietitians (tm) would be quick to point out that all us fatties need to do is just stop eating altogether.

What has me confused that the rule of 5% in 2 months seems to be applied across the board. Surely, if weight was the real issue here the rule would be simply "come back once you're under xx kg, in your own time".

Tombi!

Shenshen wrote: »

It isn't for me, I find exercise much more efficient. But I may be the exception to the rule, as most of AH's qualified and accredited dietitians (tm) would be quick to point out that all us fatties need to do is just stop eating altogether.

And can you point out where people told you to stop eating altogether?

Piliger

Shenshen wrote: »

I'm no doctor, but just from personal experience, there would be no healthy way for someone weighing 100kg to lose 5kg in 2 months.
I've been working my way down the scales for the last 3 years now, and to achieve 1kg loss in one month, I'd be restricted to 1600 kcal a day. To lose more than twice that, you'd be down to around 1000 kcal. It'll take some very interesting food plan to convince me that that would be healthy.

Not to mention that the quickest way to gain weight is a crash diet like that - the yo-yo effect would very likely to pile all that back on again after the operation, and then some.

I see absolutely no reason why not. More likely it is just difficult. And this is at the heart of the reason why these people are obese to start with. They have no self discipline and expect to lose weight in an easy way. It was very 'easy' to get obese to start with ! Not the price has to be paid to lose it.

And this yo yo effect is yet again only a psychological issue. if a person wants the public to pay for surgery they should be told to lose it or f*ck off.

Greenmachine

Weight can be lost 100% through diet alone. It is a question of how much however. If someone is massively overweight if most cases it is from over eating. The relative stability of the persons weight will factor in the whole thing. If a person is sufficently overweight they could drop 2lb per week with diet of 2000 kcal alone. There are quite a few variable however muscle mass vs fat, metabolism etc.

MarkAnthony

Greenmachine wrote: »

Weight can be lost 100% through diet alone. It is a question of how much however. If someone is massively overweight if most cases it is from over eating. The relative stability of the persons weight will factor in the whole thing. If a person is sufficently overweight they could drop 2lb per week with diet of 2000 kcal alone. There are quite a few variable however muscle mass vs fat, metabolism etc.

If you eliminate certain food groups you can see silly reductions it's how Slimming World works. I'm 18st, I think I lost 5lb in the first week without even trying. Eventually I was down to a 1.5/2lb loss per week but I wasn't hungry.

Don't know why I stopped in all honesty!

Shenshen

Brutal Deluxe wrote: »

And can you point out where people told you to stop eating altogether?

Post #33

Tombi!

Shenshen wrote: »

Post #33

This one?

Piliger wrote: »

No one is being denied medical care. Jut not major costly surgery.