Lose it or lose out

[Gob]

Patients who smoke or are very obese are being denied routine operations by cost-cutting NHS managers.

Bosses in Northern, Eastern and Western Devon Clinical Commissioning Group said the measures are ‘urgent and necessary’ to help recover a £14.5 million debt.

Under a policy to be introduced this month, morbidly obese patients will have to lose a certain amount of weight before they will be put forward for any non-urgent operations.

These patients have a body mass index of 40 or higher which is equivalent to a 6ft man weighing just over 20 stone.

The CCG – which covers a population of 900,000 – has yet to decide how much weight they must lose but it could be several stone to bring them down into the ‘obese’ or ‘overweight’ range.

Similarly, it is demanding that smokers give up for at least six weeks before being put on the waiting list for all non-urgent surgery.

But experts accused managers of ‘prescriptively’ rationing vital treatment from patients just because of their lifestyle choices.

Tam Fry, of the National Obesity Forum, pointed out that operations such as hip and knee replacements would be hugely beneficial for the obese in helping them exercise.

‘This is a prescriptive and cost-cutting measure.’

‘Such operations would be hugely cost effective in the long term and highly beneficial for patients.

‘It’s just rationing.’

The organisation said it had no choice and needed to ensure there was enough money to care for patients during the busy winter months.

But it is not the first time managers have resorted to such arbitrary measures to cut costs.

In 2012 it emerged that a quarter of trusts were restricting at least one procedures from the obese or smokers – although in most cases it was IVF.

At the time, managers pointed out that surgery can be riskier and less effective for patients who are very overweight or who smoke.

They are more likely to develop potentially fatal complications as a result of the general anaesthetic including pneumonia, blood clots, heart attacks or kidney failure.

Hip and knee replacements tend to be less successful in the obese and there is also evidence they benefit less from IVF.

As part of its cost-cutting measures, the CCG is also making it harder for all patients to have cataract surgery or hernias removed.

They will have to meet certain criteria before being eligible which might include a certain amount of sight loss or having restricted movement.

[Scooter]

If you are engaging in behaviour that is going to put you at huge risk for complications and/or undoing the effectiveness of whatever procedure you are undergoing, damn fucking straight you need to adjust your lifestyle before anyone wastes a cent treating you.

[wesw]

beer drinkers and cheeseburger eaters will no longer be treated either. waste of time.

anyone engaging in sex will not be treated for STD s, as they knew how to prevent their illness.

celibate subsistence farmers who never venture in from wilds will be the only ones welcome in our hospitals, but only if they don t eat fish with high mercury levels

[Scooter]

If you can't comprehend the very real and very direct relationship between extreme obesity or smoking and surgical complications and failure of surgical outcomes, then why are you even bothering to comment? If your goal is prove the extent of your ignorance, then by all means keep talking.

[rubato]

People are free to self-inflict as much damage as they want. The rest of us are free not to waste resources on them. Why would we bother to give a new liver to an active alcoholic?


Although I would provide assistance in losing weight, quitting smoking, and rehab for alcohol and drugs.


yrs,
rubato

[wesw]

I can. and in the 80 s there was a real direct relationship between anal sex and AIDS, should we have denied the sufferers treatment if they had engaged in the risky behavior after learning of the connection?

your a mean man and I m putting you on my "no see" list.

[Scooter]

Whether or not people continued to engage in risky sex was not going to hinder the effectiveness of their HIV treatment, so there is no comparison between that and the effects of smoking and obesity on surgical outcomes.

In fact, it has since been proven that HIV treatment is effective not only in maintaining the health and prolonging the lives of people infected with HIV, but is also highly effective in preventing transmission of HIV. That's called a win-win.

[wesw]

you re

[rubato]

Anal sex does not inherently cause HIV anymore than drinking water causes giardia or breathing causes flu.

Homophobia and ignorance popularized it. I'm surprised that there is even one person left who repeats such crap.


yrs,
rubato

[wesw]

no one said it inherently caused AIDS. it facilitated its transfer from one person to another, just as IV drug use, and transfusions of blood did. paint me as a homophobe if you want, but can you produce one comment where I denigrated someone because of their sexuality?

not my business.

[Scooter]

you re

That was certainly more insightful than most of your posts.

[Scooter]

no one said it inherently caused AIDS. it facilitated its transfer from one person to another, just as IV drug use, and transfusions of blood did.

But it didn't inhibit the effectiveness of treatment, as obesity and smoking do, so your comparison is bogus.

[Big RR]

Such operations would be hugely cost effective in the long term and highly beneficial for patients.

Call my a cynic, but somehow I think the first rationale given for the policy drove it far more than the second. So far as I can see, it is not a physician making that statement; most likely someone on the finance side. Clearly if there are medical reasons to deny treatment until certain other goals are reached, they should be followed. As for financial savings, we each have to decide how much we're willing to let that tail wag the dog, but if resources are severely limited, that must be taken into account.

And FWIW, I severely doubt that obesity affect the outcome of cataract surgery which is ordinarily done by laser under local anesthetic.

[Scooter]

The quote you are responding to was actually made by someone opposing the policy i.e. someone arguing, against all evidence, that giving a 650lb 4-pack-a-day smoker a joint replacement is going to be successful and risk free.

And to the extent that any condition or lifestyle practice impairs circulation, as obesity clearly does, it has an effect on surgical outcomes, whether performed by laser or any other means.

[wesw]

RR, that s a sensible approach. it s a slippery slope they are heading down....

"all fat people to the soylent green factory " is what lies at the bottom of the slope

[Big RR]

The quote you are responding to was actually made by someone opposing the policy i.e. someone arguing, against all evidence, that giving a 650lb 4-pack-a-day smoker a joint replacement is going to be successful and risk free.

And to the extent that any condition or lifestyle practice impairs circulation, as obesity clearly does, it has an effect on surgical outcomes, whether performed by laser or any other means.

scooter--I stand corrected; thanks for pointing it out. It's a problem of rapidly scanning all the posts. But again I do think that if the medical indicators suggest the outcome of any procedure would be much better for the patient and the waiting period is not contraindicated, then by all means the patient should lose weight before the procedure if they can. If the rationale is economic, it should be part of a coordinated effort to decide when and where the limited resources should be applied, and whether a procedure would produce a better and more durable outcome in, e.g., an otherwise fit 87 year old woman of an obese 47 year old man; obesity and smoking should not be the only criteria, nor should surgery and other treatments be withheld to punish a person for his or her lifestyle choice as some here have apparently suggested.

As for cataracts, as I recall, the main concern with obesity has to do with obesity related conditions (like diabetic retinopathy) and increased intraocular pressure observed in some obese people; however, such conditions can be screened for and the effects minimized by alternative procedures; generally poor circulation is not problem as the cornea (where the nicision is made, has no blood supply and the lens is removed and replaced by a manufactured one). It is an outpatient procedure and is characterized by rapid recovery.