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

ceadaoin. · 04-12-2014 05:41PM #1

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 · 04-12-2014 05:46PM

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.

04-12-2014 05:48PM

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 · 04-12-2014 05:50PM

That's me Double ballsed so

Ashbx · 04-12-2014 05:51PM

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 · 04-12-2014 06:02PM

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 · 04-12-2014 06:05PM

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 · 04-12-2014 06:06PM

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 · 04-12-2014 06:08PM

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 · 04-12-2014 06:11PM

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

04-12-2014 06:17PM

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 · 04-12-2014 06:22PM

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. · 04-12-2014 06:25PM

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 · 04-12-2014 06:26PM

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 · 04-12-2014 06:31PM

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 · 04-12-2014 06:33PM

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 · 04-12-2014 06:36PM

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 · 04-12-2014 06:42PM

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.

04-12-2014 06:43PM

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 · 04-12-2014 06:43PM

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 · 04-12-2014 06:44PM

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.

04-12-2014 06:46PM

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 · 04-12-2014 06:47PM

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 · 04-12-2014 06:50PM

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

04-12-2014 06:52PM

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 · 04-12-2014 06:54PM

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 · 04-12-2014 06:59PM

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 · 04-12-2014 07:03PM

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! · 04-12-2014 07:07PM

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 · 04-12-2014 07:09PM

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. · 04-12-2014 07:12PM

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.

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

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