UK To Ban Surgery For Smokers and The Obese To Reduce Health Care Costs

lemurcat12

Alatariel75 wrote: »

LiveLoveFitFab wrote: »

Here in Canada we just tax the crap out of cigarettes and throw the money back into health care. I think a carton of smokes here is 80 bucks or something. For ten dollars in actual cigarettes.

If they could tax the obese, they would too.

Either way, when I had jaw surgery they wouldn't do it if I was still smoking. It wouldn't have healed right and there would have been complications, especially since they broke it by cutting into my mouth and gums, so I had to quit. Plus, smoking with a broken jaw is really difficult.

In Australia, that carton of smokes would cost you $200-250, easy.

Here's (http://apps.who.int/gho/data/view.main.TOB33200) an interesting comparison of cig taxes as a percentage of price in all the different countries (as of 2014). Looks highest in the UK, similar in Canada and Australia, lower in the US but still quite high (in the US it varies by state or has extra taxes in different states, though, not sure how that was addressed, didn't read the information enough).

youngmomtaz

VintageFeline wrote: »

Rosemary7391 wrote: »

VintageFeline wrote: »

Yeah it's not a total ban and appears to only be in one area. There are just minimum requirements related to weight and smoking cessation. In the case of hip and knee replacements the outcomes are better for those with a lower weight so it makes sense to try and improve that by reducing body weight. They have 9 months to do so. Smoking has to be stopped for 8 weeks.

So it's a pretty narrow range and not necessarily a bad thing.

Yes, it looks more like trying to get the optimum outcome for the patient rather than pure cost cutting. If it was for any surgery then that'd be different, but I guess hip and knee surgery is particularly badly affected by weight. Not sure how smoking fits into it, but as switching to vaping is an option then that doesn't seem a huge hurdle - the waiting list is likely to be longer than the time you'd have to switch for so probably very little delay!

Smoking I think is also a risk factor in less than ideal outcomes/post surgery complications.

I would assume smoking affects blood pressure and heart rate, and oxygen saturation.

My mom has breast cancer. Before her double mastectomy, and reconstruction(same surgery), she had to quit coffee/chocolate/caffeine as a whole for a month and was not allowed any until 2montha post op. This was due to blood flow and narrowing of vessels down to the capillaries. Seems to me like requiring smokers to lay off before and after would affect healing similarity.

MeanderingMammal

RuNaRoUnDaFiEld wrote: »

Also start charging for hospital prescriptions. Why do I get me tablets from the hospital free when the NHS is almost bankrupt?

It's not really that clear cut. I was taken in an ambulance to St Thomas's in February. I was given immediate medication to stabilise the condition, but the follow on prescription was one I paid for at the hospital pharmacy.

I don't think you could reasonably suggest that medication during a hospital stay could be chargeable. That said I'm conscious that different CCGs will take different approaches to medication.

MeanderingMammal

animatorswearbras wrote: »

How do we fix it? Well here's my twopence worth, the biggest one is PFI's implemented by successive governments are an investment con and are basically loan shark interest rates made by private firms to suck money out of the NHS that should be spent on the front line, they should all be stopped.

The observation that I'd make about PFIs is that the vast majority of people expressing an opinion on them have no real idea how they work. I'd also observe that a number of audits that I've been involved in would suggest that public sector contract managers generally don't manage them particularly well, and equally don't really understand how to exploit them effectively.

..the privatisation of certain services...

Like GPs surgeries, that have been privately owned throughout the life of the NHS?

The NHS isn't perfect but it's as near as we'll ever get

I've done a few jobs in the health sector, and I'd note a few issues that impact on funding:

• An ever increasing range of available treatments
• Excessive political interference at both national and local level
• Excessive delivery complexity
• Chronic waste and inefficiency
• Consumer expectation
• Systemic local authority failure to address cause in social care, instead relying on treating effect
• Commercial naivety
• Underlying government budgeting mechanisms, that encourage short termism

MeanderingMammal

g_poleman wrote: »

Omg people it's Govt run "free" health care. What do you expect??? The people here in the US that buy into single payer are going to get this. This stuff is not hard to figure out if you are thinking. Certain politicians in this country like to act like Santa and hand out free everything. Free comes at a price. S Palin was mocked and called stupid for talking about "death panels". Well what do you think this is??? An overloaded system will at some point decide for us who is treated and who is not. Get a clue people in the US before it's too late.

I suspect it would be a breach of board T&Cs to suggest that you're an idiot, so I won't do that.

MeanderingMammal

stanmann571 wrote: »

NHS did in fact refuse care that could have prolonged or preserved life earlier this year.

What case are you thinking about?

RuNaRoUnDaFiEld

MeanderingMammal wrote: »

RuNaRoUnDaFiEld wrote: »

Also start charging for hospital prescriptions. Why do I get me tablets from the hospital free when the NHS is almost bankrupt?

It's not really that clear cut. I was taken in an ambulance to St Thomas's in February. I was given immediate medication to stabilise the condition, but the follow on prescription was one I paid for at the hospital pharmacy.

I don't think you could reasonably suggest that medication during a hospital stay could be chargeable. That said I'm conscious that different CCGs will take different approaches to medication.

You paid for a prescription at the hospital pharmacy?

That was what my point. I was given it free.

Maybe different trust's have different rules. Mine was County Durham

MeanderingMammal

saintor1 wrote: »

Surgery Ban For Patients Who Smoke And Are Obese
Hospital leaders in North Yorkshire, England, announced that procedures such as hip and knee surgeries will be denied to certain individuals until they improve their health.

It may be worth highlighting, for the benefit of non-Britons reading this, that the NHS isn't a monolithic organisation. We have a Department of Health that sets policy, and owns a number of national capabilities, but the majority of healthcare provision sits at a more loal level with clinical commissioning groups. These CCGs make decisions about how public money is expended based on local demographic needs, and what this article is reporting is a CCG identifying that success criteria for specific treatments are significantly improved by a couple of fairly straightforward mechanisms.

CCGs might buy services from privately owned or publicly owned sources, with the principles that the internal market increases efficiency.

Unknown

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VintageFeline

suzannesimmons3 wrote: »

RuNaRoUnDaFiEld wrote: »

MeanderingMammal wrote: »

RuNaRoUnDaFiEld wrote: »

Also start charging for hospital prescriptions. Why do I get me tablets from the hospital free when the NHS is almost bankrupt?

It's not really that clear cut. I was taken in an ambulance to St Thomas's in February. I was given immediate medication to stabilise the condition, but the follow on prescription was one I paid for at the hospital pharmacy.

I don't think you could reasonably suggest that medication during a hospital stay could be chargeable. That said I'm conscious that different CCGs will take different approaches to medication.

You paid for a prescription at the hospital pharmacy?

That was what my point. I was given it free.

Maybe different trust's have different rules. Mine was County Durham

Wales and Scotland have free prescriptions for everyone.....

And County Durham is in England. As is St. Thomas’

RuNaRoUnDaFiEld

suzannesimmons3 wrote: »

RuNaRoUnDaFiEld wrote: »

MeanderingMammal wrote: »

RuNaRoUnDaFiEld wrote: »

Also start charging for hospital prescriptions. Why do I get me tablets from the hospital free when the NHS is almost bankrupt?

It's not really that clear cut. I was taken in an ambulance to St Thomas's in February. I was given immediate medication to stabilise the condition, but the follow on prescription was one I paid for at the hospital pharmacy.

I don't think you could reasonably suggest that medication during a hospital stay could be chargeable. That said I'm conscious that different CCGs will take different approaches to medication.

You paid for a prescription at the hospital pharmacy?

That was what my point. I was given it free.

Maybe different trust's have different rules. Mine was County Durham

Wales and Scotland have free prescriptions for everyone.....

Yes and I think it is crazy.

We have a system that is extremely under funded and we give medications away free.

Most people can afford £8.60

MeanderingMammal

suzannesimmons3 wrote: »

RuNaRoUnDaFiEld wrote: »

MeanderingMammal wrote: »

RuNaRoUnDaFiEld wrote: »

Also start charging for hospital prescriptions. Why do I get me tablets from the hospital free when the NHS is almost bankrupt?

It's not really that clear cut. I was taken in an ambulance to St Thomas's in February. I was given immediate medication to stabilise the condition, but the follow on prescription was one I paid for at the hospital pharmacy.

I don't think you could reasonably suggest that medication during a hospital stay could be chargeable. That said I'm conscious that different CCGs will take different approaches to medication.

You paid for a prescription at the hospital pharmacy?

That was what my point. I was given it free.

Maybe different trust's have different rules. Mine was County Durham

Wales and Scotland have free prescriptions for everyone.....

Isn't clinical performance in Scotland suffering at the moment?

This plays in to my observations about the structure of public health care in the UK, with the NHS bodies in Scotland, Wales and England being a layer subordinate to the Department(s) of Health that I didn't specifically refer to. The devolved nature of some areas of policy is probably a complexity too far for the majority of readers.

That said, prescription charging is a good example of cost growth in the various services. Whilst many in England contribute to prescription costs it's a heavily subsidised system. Many prescriptions cost the service more than the charge, and there are many opportunities for individuals to reduce their liability. Pre-payment certificates for example become cost effective at quite a low level, and are reasonably affordable.

MeanderingMammal

RuNaRoUnDaFiEld wrote: »

MeanderingMammal wrote: »

RuNaRoUnDaFiEld wrote: »

Also start charging for hospital prescriptions. Why do I get me tablets from the hospital free when the NHS is almost bankrupt?

It's not really that clear cut. I was taken in an ambulance to St Thomas's in February. I was given immediate medication to stabilise the condition, but the follow on prescription was one I paid for at the hospital pharmacy.

I don't think you could reasonably suggest that medication during a hospital stay could be chargeable. That said I'm conscious that different CCGs will take different approaches to medication.

You paid for a prescription at the hospital pharmacy?

That was what my point. I was given it free.

Maybe different trust's have different rules. Mine was County Durham

Not for the treatment I received when I was there, but when I was discharged with a follow on course. Different acute trusts do have that flexibility around how they attribute costs of treatment.

Unknown

This content has been removed.

Fuzzipeg

Can most people afford £8-60? Families on tax credits and associated benefits, when they change to the incoming one are reported to loose a substantial amount of money, they are supposed not to, it should only be on re-application. (they may still be exempt but not those just above help) I know the children get medications free. Thinking back to a previous incarnation, lone parent of two, tight budget, I would have put food on their plates before medication for me. I know there are prepayment for regular prescriptions, I have no idea what the charge is for these now. I used to work for the local Health Authority when it was best part of £100 for was it a year, it was a very long time ago, 20 years, finding that money up front would have been impossible for me way back then even for a part year.

I know there are conditions which carry exemptions you have to apply for! Diabetes is one. Another of them is, oh dear, my pet "bee in my bonnet", is escaping yet again, being hypo thyroid, but if it don't work for you, it simply just won't work, so you loose your job at some stage, as your health goes down hill because of the accumulation of interrelated problems which are all seen as independent.

I'm glad those in Scotland and Wales and it seems isolated areas of England are able to have free prescriptions. It seems as if their financial departments are prepared to stand the cost of every script to save money chasing prescription fraud, taking the risk there are some items waiting on bathroom or kitchen shelves, at least the people in medical and financial predicaments are able to have what they need and will not progress to needing more expensive interventions like, operations or home support as soon as otherwise.

There should be no division in the care provision. Allowing the local area to join up the social care and medical care without spending more taxation be it general or local rates, to decide which provider offers this or that would make things more freely so people can have the hospital beds when they need them and those, "bed blocking", shameful term, because they can't get home or to care because they are waiting on finding a place or having essential equipment provided. I'd best not start on our housing stock, that is too off topic.

I'll go with, its good to have a Living wage or what ever title it goes by now and work place pension provision. The problem is these much deserved increases and extra employers nation insurance contributions, as well as the employee's, have to be found from some where. Central government payments to local authorities are capped/cut so the care facilities will go out of business because the care costs are not being met. Not forgetting, there are many workers within the NHS who qualify for this rise too, this reduces the money available for patient care!

Its a multifaceted problem and blaming those who are ill because of some or several, probably undiagnosed problem is not the way to go.

MeanderingMammal

Fuzzipeg wrote: »

I'm glad those in Scotland and Wales and it seems isolated areas of England are able to have free prescriptions. It seems as if their financial departments are prepared to stand the cost of every script to save money chasing prescription fraud, taking the risk there are some items waiting on bathroom or kitchen shelves, at least the people in medical and financial predicaments are able to have what they need and will not progress to needing more expensive interventions like, operations or home support as soon as otherwise.

You'll note that I commented on other performance within NHS Scotland. The strategic choice to centrally fund prescriptions means that other things aren't being funded, as a result clinical outcomes are worsening.

The reality is that there are significant challenges around affordability in health, never mind across the welfare system. We're in a situation where we need to make decisions about where we stop finding treatments. Are there treatments that are currently available on the NHS that shouldn't be public funded? That then starts to open the debate about personal contribution to a condition. Going back to the original point, smoking is a choice and if we're going to have this public debate there are good arguments that smoking related conditions shouldn't be vote funded.

As you highlight, that has a consequential impact elsewhere in the welfare system.

There should be no division in the care provision. Allowing the local area to join up the social care and medical care without spending more taxation be it general or local rates, to decide which provider offers this or that would make things more freely...

Notwithstanding that joining up decision making already happens there are significant constraints around outcomes. In part that's driven by planning horizons, as well as the nature of the relationship between central and local government writing the annual budgeting cycle.

I'll go with, its good to have a Living wage or what ever title it goes by now and work place pension provision. The problem is these much deserved increases and extra employers nation insurance contributions, as well as the employee's, have to be found from some where. Central government payments to local authorities are capped/cut so the care facilities will go out of business because the care costs are not being met. Not forgetting, there are many workers within the NHS who qualify for this rise too, this reduces the money available for patient care!

I'm not really clear on what you mean here, are you supporting our rejecting the idea of a living income?

Fuzzipeg

I whole heartedly support the idea of a living wage. I only pointed out it has to be paid for and it dos not seem to be happening and gave a couple of reasons why. I was introduced to the idea of inverse taxation many years ago bringing the least well off up to an acceptable level, (decided by someone other than me, I would not know where to set it), an automatic payment to the least well off, they receive rather than pay tax. Their contribution is their work. Then there is the idea, every adult has a income from the state and then pays higher tax on anything they earn above. Some countries are making it work, sorry can't remember which.

I know there are cry's that employers should pay more but it comes to an impasse because services etc, are cost sensitive. I believe that all jobs in a society are to be valued. We would be in a very sorry state without our street sweepers and people in similar positions, even auxiliary nurses or what ever designation they are given in care facilities, who can be looked down on by some as inferior, because they do what can be dirty jobs, with compassion.

I'm old, I do believe a person should cut their coat according to their cloth, personal choice/responsibility too. Its what I had to do. I feel for the youngsters who can't afford their own homes, rented or otherwise, we have a pitiful housing stock. I remember a time when the interest rates were 16%, that was something like 30 years ago, its only got worse since then.

To bring this back to the thread: I know a couple, he was taken seriously ill out of area, way back in the summer, he was repatriated to the local General, needed Regional input on a couple of occasions, he is not out of the wood yet. My point, this active couple live in their house, when he comes home they will probably need something on one floor and down stairs. There is nothing in the area which would fit their circumstances, if there were selling up takes time, there are few bungalows or ground floor flats. There is more to this than blaming, scapegoating people.

As I said earlier, Allowing the NHS to look into and taking on modern medical advances/approaches could alleviate serious health conditions without surgical interventions. (is it Michael Mosley etal there are others) So much is being learned about how our bodies work and how they go wrong, much of it involves micro nutrients through supplements to get people back to the straight and narrow. Not everyone is born with a perfectly functioning body, though we all know ours does, how it works is all we know, its normal? It has to work like everyone else's? doesn't it? In my case it was not. Just needed to improve my personal chemistry. The couple I mentioned experienced are experiencing a freak incident.

One thing is for sure, there is no simple way out of this mess.

maryannprt

animatorswearbras wrote: »

g_poleman wrote: »

Omg people it's Govt run "free" health care. What do you expect??? The people here in the US that buy into single payer are going to get this. This stuff is not hard to figure out if you are thinking. Certain politicians in this country like to act like Santa and hand out free everything. Free comes at a price. S Palin was mocked and called stupid for talking about "death panels". Well what do you think this is??? An overloaded system will at some point decide for us who is treated and who is not. Get a clue people in the US before it's too late.

I really have no idea what you are on about, death panels? Crikey is this what some American's think... how embarrassing for you, lol.

Right wing wackos think we'll have death panels. Normal Americans don't think that. The government will kill your old granny because she's no longer a productive member of society. Just ask Sarah Palin.