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Thread: NHS provokes fury with indefinite surgery ban for smokers and obese

  1. #1
    Member
    Registered: Nov 2016
    Location: Trollinus Maximus

    NHS provokes fury with indefinite surgery ban for smokers and obese

    http://www.telegraph.co.uk/news/2017...d=tmg_share_fb
    The NHS will ban patients from surgery indefinitely unless they lose weight or quit smoking, under controversial plans drawn up in Hertfordshire.

    The restrictions - thought to be the most extreme yet to be introduced by health services - immediately came under attack from the Royal College of Surgeons.
    thought HC was a "right" in Europe?

  2. #2
    Member
    Registered: Apr 2002
    Location: Third grave from left.
    Don't know anything about the subject, don't live there, did not read the article ... BUT ...

    Assuming "telegraph" is not garbage news source (well, every news source is from probabilistic point of view complete trash) and the story is not horribly tilted / misreported - here goes:

    The word is that surgery failure rate for obese and/or smokers is very high - till the risks can be lowered (lose weight / quit smoking) the surgery should be postponed if at all possible (ie. not an emergency / postponing is not worse). Health profession has an obligation to do no harm. Surgery is harm that must be overcome/justified by the expected results and their chances.

    Looks perfectly reasonable to me.

    (if anyone has any actual knowledge of the actual details - i'm intrigued)

  3. #3
    Administrator
    Registered: Sep 2001
    Location: above the clouds
    The telegraph has been around a long time as one of the established newspapers in the U.K. Allegedly reliable.

    The source of this policy seems vague. Is it NHS management? Difficult to know what's going on without more detail.

  4. #4
    Moderator
    Registered: Apr 2003
    Location: Wales
    Yes, the Telegraph is broadsheet not tabloid and has a conservative/tory inclination. As I understand it, this is one county out of 48 in England. There seems to be quite a lot of opposition, particularly from surgeons, so whether this will actually be implemented remains to be seen.

    @ zombe's point

    West Hertfordshire Hospitals Trust medical director Michael van der Watt, wrote to the CCGs warning of “significant opposition” to the proposals at the trust. He said: “There is a wealth of evidence that does not support the theory that worst outcomes occur in patients with a BMI greater than 30”.
    As to that, we need SubJeff.

  5. #5
    Member
    Registered: Apr 2002
    Location: Third grave from left.
    My guess, still having not read the damn thing, is that in principle sane and justified proposed policies are worded inadequately rising possibilities for misuse - in extreme and highly hypothetical/unrealistic cases "(in effect) indefinite (unjustified) surgery denial". Something any sane surgeon would be overly critical about given the legal/bureaucracy burdens it would impose. OR. Just misunderstood.

    Just a guess.

    edit: @nickie
    That is an interesting quote. One would expect new proposed policy of this kind to be based on solid evidence - yet the quote seems to contradict that.

    Yeah, please, someone who knows what is going on - please speak up.

    --------------------------
    The article title ringed all the alarm bells for me (hence why i did not bother to read it and just scrolled over it for a minute or two).

    "NHS provokes fury ..." - bad language.
    "... with indefinite surgery ban ..." - blanket statement (essentially click-bait in disguise as the reader will have to read the damn thing in hopes to find the answer to the implied and preposterous question)
    Last edited by zombe; 20th Oct 2017 at 11:02.

  6. #6
    Administrator
    Registered: Sep 2001
    Location: above the clouds
    I don't bother reading news because it's often selling something exaggerated with little real information. Then people aligned with certain opinions repeat the "facts". How much can be learned from the news?

    I hadn't noticed it was a particular trust making the suggestion. This would mean it's not a countrywide thing. The NHS is split into trusts with certain regions as far as I know.

  7. #7
    Member
    Registered: Apr 2002
    Location: Third grave from left.
    Having now read the thing (much more like a news report, sans references, that i would have expected from the title):

    There is something wonky in Hertfordshire ( one might even say that there is some zombe in Hertfordshire ).

    If true then from what little details there (*) are it indeed looks like a bureaucracy mess bound to harm thous it is claiming to benefit even if the justification of surgery failure chances were true (which is claimed by some dude to not be true either).

    *) the article seems to have 0 web-references and the topic policy is not in the article either.

  8. #8
    Member
    Registered: Aug 2004
    The NHS is going to have all kinds of problems and obnoxious attempts at solutions until its funding is restored. What we're seeing here is the classic "Sabotage a program, blame it for the failure" tactic that has taken root across the right wing. They can't win on the merits, so subterfuge is everything.

  9. #9
    Member
    Registered: Nov 2001
    Location: uk
    Quote Originally Posted by scumble View Post
    I hadn't noticed it was a particular trust making the suggestion. This would mean it's not a countrywide thing. The NHS is split into trusts with certain regions as far as I know.
    Primary Care Trusts have been replaced by Clinical Commissioning Groups. There are apparently 207 of them and they as far as I can tell are the bit of the NHS that decides who to pay for what, where.

    This particular CCG has decided that it does't like large people (not necessarily fat people, BMI takes no account of what your body is made of just how much it weighs) and has asked local people via a leaflet in GPs surgeries, local papers and various other methods what they think of this idea. Most of the people who responded were in favour of it and so they're going ahead with it even though when they asked the local hospitals they thought it was a daft idea.

    For anyone who like me struggled to read the linked article in the telegraph that looked like it's been shoved through google translate in a variety of languages to get something as hard to read as possible
    Original press release type thing is http://www.enhertsccg.nhs.uk/news/20...ions-announced
    and the actual thing it relates to is https://www.healthierfuture.org.uk/s...-Papers-v1.pdf (linked at the bottom of the above)

  10. #10
    Member
    Registered: Nov 2003
    Location: Poland
    You know, I basically got roped into alcohol past 30, but I stilll can't understand the appeal of tobbaco.

  11. #11
    Moderator and Priest
    Registered: Mar 2002
    Location: Dinosaur Ladies of the Night
    *HACK* *COUGH* *HUK* *HUK* *HUK* *HOOOOOCCCCKKKKKK* nothing beats a good cigarette first thing in the morning, or just after finishing a big meal, Van. Nothing.

  12. #12
    Member
    Registered: May 2004
    It's little more than satisfying a craving caused by your own dependence. And I say that as an ex-smoker. If I were to smoke a cigarette now, I'd find it absolutely disgusting.

    It's a bit like going thirsty for two days and then finding a glass of water the best drink you ever had.
    Last edited by Starker; 22nd Oct 2017 at 20:00.

  13. #13
    Still Subjective
    Registered: Dec 1999
    Location: Idiocy will never die
    Quote Originally Posted by caffeinatedzombeh View Post
    not necessarily fat people, BMI takes no account of what your body is made of just how much it weighs
    True, but for the vast majority of people it's fat.

    Even so, a blanket ban on BMI over 30 is an odd choice, especially as sometimes the ailment is stopping the patient from losing weight - e.g. knee replacement.

    The Royal College of Surgeons is against this so it'll be quashed.

  14. #14
    Administrator
    Registered: Sep 2001
    Location: above the clouds
    Yes I had the feeling it may be a journalistic attempt to work up something quite small into a "headline". They might have had good intentions.

  15. #15
    New Member
    Registered: Oct 2017
    I'm not from the UK but I read The Telegraph occasionally and for me it feels sensationalist at times. As speculated, the reason is probably not to punish smokers and obese people, but to reduce risk. A controversial headline just sells better.

  16. #16
    Member
    Registered: Dec 2006
    Location: Washington DC
    The headline is 'indefinite surgery ban for smokers and obese' but the actual content is 'non-urgent surgery will be postponed for patients with persistent risk factors'. They're saying that for people where invasive surgery has much higher risks (eg, smokers and the obese) but isn't strictly necessary, they'll focus on non-surgical methods of treatment instead. It's incredible how much context is stripped from the headline even when the article itself corrects its own headline four sentences in.

  17. #17
    Member
    Registered: May 2004
    Oh, the headline is even more clever than that -- "NHS provokes fury...", so you know to be outraged already before you have to decide whether it's something to be outraged about.

  18. #18
    Member
    Registered: Sep 2001
    Location: Qantas
    Regardless of the headline, I can't see this as anything other than punitive. All else being equal, a smoker with a bad hip who can't get around is just as worthy of a hip replacement as a non-smoker with a bad hip who can't get around. Or one who has chronic back or neck pain due to damaged discs, or whatever. If the patient's health makes surgery risky, whether that's due to smoking, obesity, or something else entirely, that should be factored into each decision individually. Otherwise, it seems reasonable to prioritize non-urgent surgery based on who is suffering the greatest pain and/or disability, along with who can benefit the most. The proposed rules mean that people are going to be denied treatment for reasons that may be completely unrelated to their ailment, which is just plain unfair and discriminatory. In a country that believes that health care is a human right, it's surprising to me that public opinion would be in favor of treating a ground of people as second-class citizens with lesser rights.

  19. #19
    Member
    Registered: Nov 2001
    Location: uk
    CCGs don't care about any of that, they care about how much it costs and who's budget it comes out of.

    Fat people are expensive.

  20. #20
    Moderator
    Registered: Apr 2003
    Location: Wales
    Quote Originally Posted by heywood View Post
    In a country that believes that health care is a human right, it's surprising to me that public opinion would be in favor of treating a ground of people as second-class citizens with lesser rights.
    More like a number of smug ex-smokers and skinny people see the smokers and obese as less than human.

    It really grieves me to see the increase in downright meanness in this country. If it isn't the smokers and obese costing money it's the immigrants and health tourists. Never mind we're losing doctors and other health workers in greater numbers than before, going back home before they're kicked out. And all those moaning about immigrants will soon be moaning even louder about not getting their operations because of lack of staff or not able to get a GP appointment etc.

    And will these people who are denied non-urgent surgery get a tax rebate, I wonder. We do pay taxes for our health care. It isn't free.

  21. #21
    Member
    Registered: May 2004
    Quote Originally Posted by heywood View Post
    In a country that believes that health care is a human right, it's surprising to me that public opinion would be in favor of treating a ground of people as second-class citizens with lesser rights.
    Well, let me ask you this... In your home country, do you have counties that do things differently from the rest of the state? Why would you be surprised that there is such a county in the UK?

  22. #22
    Member
    Registered: Sep 2001
    Location: Qantas
    Of course there are going to be differences from locale to locale. That's not the point. The policy decision was justified based on polling and I'm surprised such a high percentage of people (85%) are in favor a policy that is blatantly discriminatory.

  23. #23
    Member
    Registered: May 2004
    Well, I'm going with nickie's answer then that there are probably lots of smug ex-smokers and skinny people in that county that hate smokers and obese people.

  24. #24
    Moderator
    Registered: Apr 2003
    Location: Wales
    Perhaps it's a class thing: middle class (like voting) perceiving working class and unemployed as obese chain-smokers and probably don't pay taxes towards their health care. (Massive generalisation).

  25. #25
    Member
    Registered: May 2004
    In the UK, people in general seem to like the idea of Tory austerity and underfunding the NHS. Or at least enough to re-elect them.

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