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UK To Ban Surgery For Smokers and The Obese To Reduce Health Care Costs
saintor1
Posts: 376 Member
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.
I have no problem that negligent people pay more.
EDIT: added source
http://www.techtimes.com/articles/215066/20171101/uk-to-ban-surgery-for-smokers-and-the-obese-to-reduce-health-care-costs.htm
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Replies
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So if im a smoker, and have knee problems, they'll deny me surgery?
What if someone who has never worked, is lazy, but not a smoker nor obese needs surgery? Theyll get it... what about someone who has worked all their life, is a smoke or obese, paid taxes for 30+ years, they wont get surgery?
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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.
I have no problem that negligent people pay more.
Is this just for one region i.e. North Yorkshire or a nationwide rollout?2 -
Source?2
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ManBehindTheMask wrote: »So if im a smoker, and have knee problems, they'll deny me surgery?
What if someone who has never worked, is lazy, but not a smoker nor obese needs surgery? Theyll get it... what about someone who has worked all their life, is a smoke or obese, paid taxes for 30+ years, they wont get surgery?
Unless a doctor determines it is more detrimental to your health to wait longer. Full story is here: https://www.laboratoryequipment.com/news/2017/11/uk-region-imposes-surgery-ban-smokers-obese-patients1 -
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.10 -
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!1 -
As an admittedly right-leaning higher-rate-tax-paying Brit who has had significant but non-urgent surgery on the NHS, I'm on board with this.
Off to look up what my CCG is doing!
The NHS is in dire financial straits, so significant measures do need to be taken to optimise what they do.
Post-surgical complications take time and money to deal with, so if these can be minimised, particularly for non-urgent surgery, then that's a step in the right direction.
I also think we've got too used to being able to run to the NHS for every little ill that people have forgotten how to manage a lot of things for themselves.
Often, the A&E waits are horrendous because people go to hospital because they have a cold (or something similarly insignificant - clearly an overdramatized example), when they should either deal with it at home or maybe go and see a pharmacist instead to get some advice. I don't know how we do it, but more education about what medical thing needs what level of attention/intervention would be really beneficial.
Also healthy lifestyle choices that reduce many of the (arguably) self-inflicted issues.
Addendum: Oh, my CCG has invented scratch cards. Sigh. http://www.oxfordshireccg.nhs.uk/news/scratch-cards-signpost-people-to-the-right-health-services/54610
But at least that might address the point about going to A&E for a cold!4 -
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.3 -
As an admittedly right-leaning higher-rate-tax-paying Brit who has had significant but non-urgent surgery on the NHS, I'm on board with this.
Off to look up what my CCG is doing!
The NHS is in dire financial straits, so significant measures do need to be taken to optimise what they do.
Post-surgical complications take time and money to deal with, so if these can be minimised, particularly for non-urgent surgery, then that's a step in the right direction.
I also think we've got too used to being able to run to the NHS for every little ill that people have forgotten how to manage a lot of things for themselves.
Often, the A&E waits are horrendous because people go to hospital because they have a cold (or something similarly insignificant - clearly an overdramatized example), when they should either deal with it at home or maybe go and see a pharmacist instead to get some advice. I don't know how we do it, but more education about what medical thing needs what level of attention/intervention would be really beneficial.
Also healthy lifestyle choices that reduce many of the (arguably) self-inflicted issues.
Addendum: Oh, my CCG has invented scratch cards. Sigh. http://www.oxfordshireccg.nhs.uk/news/scratch-cards-signpost-people-to-the-right-health-services/54610
But at least that might address the point about going to A&E for a cold!
We are politically different but I do agree that the overuse of hospital services in particular, is a problem that seems to be escalating. Same with calling ambulances for totally inappropriate reasons. I don't know of an obviously effective way to tackle it, there are already posters up in my GP surgery and in the pharmacies. But then it's not my job to come up with solutions so I guess I'm off the hook there.4 -
Free and universal to the deserving.
Bureaucrats and accountants will decide who deserves.17 -
To further my point, I actually walked myself to my local A&E at the time because of dreadful chest infection that as an asthmatic could kill me. They have both a walk-in centre and A&E. I actually went to the walk in first who promptly told me to bugger off to A&E because I should be seen more urgently (turns out they thought it was pneumonia, thankfully wasn't quite that bad!).
I think that model would be a great way to triage people whichever place they walk into first, send them where they should actually be.3 -
JeromeBarry1 wrote: »Free and universal to the deserving.
Bureaucrats and accountants will decide who deserves.
It's not really that bad. They can still have their surgery and if not appropriate for them to wait 8 weeks - 9 months (which is the timeframes for smoking cessation to weight loss). I am not for turning anyone down for surgery they need but I am not against trying to improve patient outcomes as that is beneficial both to the patient and the potential additional care required if there are post surgery complications that could easily be possibly prevented.5 -
VintageFeline wrote: »To further my point, I actually walked myself to my local A&E at the time because of dreadful chest infection that as an asthmatic could kill me. They have both a walk-in centre and A&E. I actually went to the walk in first who promptly told me to bugger off to A&E because I should be seen more urgently (turns out they thought it was pneumonia, thankfully wasn't quite that bad!).
I think that model would be a great way to triage people whichever place they walk into first, send them where they should actually be.
Yes, that would make a lot of sense for those turning up at the wrong place. Even if they don't get the message and keep turning up at A&E for colds that would minimise the time wasted (assuming they didn't kick up a fuss about it, which is an assumption...). I think it would be most effective to decide this sort of policy at a local level - different areas will have different problems.
Usually if you look up your symptoms on the NHS website it'll suggest where to go and when. That's helpful too. Posters in GPs and pharmacies less so because if they've gone there they're already doing something appropriate... I think we need to do more to encourage healthy living outside of direct engagement with the health services.1 -
Who could have expected this? How could we have known?4
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Rosemary7391 wrote: »VintageFeline wrote: »To further my point, I actually walked myself to my local A&E at the time because of dreadful chest infection that as an asthmatic could kill me. They have both a walk-in centre and A&E. I actually went to the walk in first who promptly told me to bugger off to A&E because I should be seen more urgently (turns out they thought it was pneumonia, thankfully wasn't quite that bad!).
I think that model would be a great way to triage people whichever place they walk into first, send them where they should actually be.
Yes, that would make a lot of sense for those turning up at the wrong place. Even if they don't get the message and keep turning up at A&E for colds that would minimise the time wasted (assuming they didn't kick up a fuss about it, which is an assumption...). I think it would be most effective to decide this sort of policy at a local level - different areas will have different problems.
Usually if you look up your symptoms on the NHS website it'll suggest where to go and when. That's helpful too. Posters in GPs and pharmacies less so because if they've gone there they're already doing something appropriate... I think we need to do more to encourage healthy living outside of direct engagement with the health services.
Wasn't the 111 telephone service introduced as such a measure?1 -
I agree with this completely, and wish more countries would roll this out. It's known that obesity and smoking are related to poor outcomes for surgery recovery. I think it's perfectly acceptable to have people be a part of their recovery and life choices are a part of that. Moreover, we all make choices that affect us, but when it affects others (higher taxes, longer wait times) people should be held accountable for their choices. Every choice has a consequence. We all as adults know this.1
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Isn't that discrimination! What about alcoholics? What about drug addiction? That will improve overall health, shouldn't they be restricted too? Oh wait a minute, I forgot, providing help to these individuals will cost the system more money, so we can't do that!6
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VintageFeline wrote: »To further my point, I actually walked myself to my local A&E at the time because of dreadful chest infection that as an asthmatic could kill me. They have both a walk-in centre and A&E. I actually went to the walk in first who promptly told me to bugger off to A&E because I should be seen more urgently (turns out they thought it was pneumonia, thankfully wasn't quite that bad!).
I think that model would be a great way to triage people whichever place they walk into first, send them where they should actually be.
That's if you have a local walk in centre though. I live in London so 9/10 I would always chose walk in over A&E (including the time I had to hop there when I had glass embedded in my foot) but many people in other areas are not so fortunate.0 -
Isn't that discrimination! What about alcoholics? What about drug addiction? That will improve overall health, shouldn't they be restricted too? Oh wait a minute, I forgot, providing help to these individuals will cost the system more money, so we can't do that!
Again, they are not being refused treatment. And they will be offered resources to help with changing their lifestyles to improve the outcomes of their surgery.
I am all for those with addictions being treated for those addictions. And often health conditions they suffer are directly linked to their addiction so ideally there would be an overall holistic approach. But these things require funding and at the moment, additional funding is not forthcoming. But I am not familiar with the protocol of surgeries such as hip replacements and addicts. I rather suspect it would be too dangerous to operate on someone with an active addiction.2 -
VintageFeline wrote: »To further my point, I actually walked myself to my local A&E at the time because of dreadful chest infection that as an asthmatic could kill me. They have both a walk-in centre and A&E. I actually went to the walk in first who promptly told me to bugger off to A&E because I should be seen more urgently (turns out they thought it was pneumonia, thankfully wasn't quite that bad!).
I think that model would be a great way to triage people whichever place they walk into first, send them where they should actually be.
That's if you have a local walk in centre though. I live in London so 9/10 I would always chose walk in over A&E (including the time I had to hop there when I had glass embedded in my foot) but many people in other areas are not so fortunate.
That's my point. I was saying the presence of both on the same site is a great idea, not that they should be sent off across a city/town to a walk in. I am also in London, the hospital I went to was St. George's.1 -
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 reduces oxygen carrying capacity = delayed healing.3 -
VintageFeline wrote: »VintageFeline wrote: »To further my point, I actually walked myself to my local A&E at the time because of dreadful chest infection that as an asthmatic could kill me. They have both a walk-in centre and A&E. I actually went to the walk in first who promptly told me to bugger off to A&E because I should be seen more urgently (turns out they thought it was pneumonia, thankfully wasn't quite that bad!).
I think that model would be a great way to triage people whichever place they walk into first, send them where they should actually be.
That's if you have a local walk in centre though. I live in London so 9/10 I would always chose walk in over A&E (including the time I had to hop there when I had glass embedded in my foot) but many people in other areas are not so fortunate.
That's my point. I was saying the presence of both on the same site is a great idea, not that they should be sent off across a city/town to a walk in. I am also in London, the hospital I went to was St. George's.
Tooting is able to offer that because it's such a large hospital. But many other local hospitals don't facilitate the option, and as such A&E feels the strain. Ideally, GP surgeries should offer this service (whether that be with a dedicated team on a non appointment schedule) to relieve the stress on other healthcare providers. I'm unsure if this is an option, but due to the unique funding of the UK healthcare and an ever increasing unhealthy population, the days of an efficient and quality NHS were always numbered.
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VintageFeline wrote: »VintageFeline wrote: »To further my point, I actually walked myself to my local A&E at the time because of dreadful chest infection that as an asthmatic could kill me. They have both a walk-in centre and A&E. I actually went to the walk in first who promptly told me to bugger off to A&E because I should be seen more urgently (turns out they thought it was pneumonia, thankfully wasn't quite that bad!).
I think that model would be a great way to triage people whichever place they walk into first, send them where they should actually be.
That's if you have a local walk in centre though. I live in London so 9/10 I would always chose walk in over A&E (including the time I had to hop there when I had glass embedded in my foot) but many people in other areas are not so fortunate.
That's my point. I was saying the presence of both on the same site is a great idea, not that they should be sent off across a city/town to a walk in. I am also in London, the hospital I went to was St. George's.
Ah I see what you mean. Yes that is a good idea and I didn't know that about St George's. Tooting is very accessible to me so I'll remember that if I have an urgent medical issue.0 -
Isn't that discrimination! What about alcoholics? What about drug addiction? That will improve overall health, shouldn't they be restricted too? Oh wait a minute, I forgot, providing help to these individuals will cost the system more money, so we can't do that!
I think it isn't quite the same. Let's say alcohol has trashed your liver. I guess it makes little difference to the outcome whether you stop drinking then get a liver transplant or get a liver transplant then stop drinking, since alcohol leaves the body pretty quickly. (Although I don't know what'd happen if you turned up for surgery drunk!) But if you lose weight, then get a hip replacement, you're gonna do much better in the long run than someone who gets a hip replacement then loses weight, since all the time you're losing the weight you're also putting extra wear on the new hip. Aren't second replacements less effective as well?
Nutmegoreo - yep, that makes sense. Although that presumably isn't specific to the type of surgery as well, like weight loss is to hip/knee replacement, so why wouldn't they ask for any surgery? It makes sense to ask people to take measures to make treatment more successful though - it's normal to be asked not to eat before some things isn't it? And I'm sure there are plenty of drugs you're not supposed to mix with alcohol/etc.1 -
The wise judgment of the death panel in socialized medicine.
Coming to a local hospital near you...soon.13 -
Rosemary7391 wrote: »Isn't that discrimination! What about alcoholics? What about drug addiction? That will improve overall health, shouldn't they be restricted too? Oh wait a minute, I forgot, providing help to these individuals will cost the system more money, so we can't do that!
I think it isn't quite the same. Let's say alcohol has trashed your liver. I guess it makes little difference to the outcome whether you stop drinking then get a liver transplant or get a liver transplant then stop drinking, since alcohol leaves the body pretty quickly. (Although I don't know what'd happen if you turned up for surgery drunk!) But if you lose weight, then get a hip replacement, you're gonna do much better in the long run than someone who gets a hip replacement then loses weight, since all the time you're losing the weight you're also putting extra wear on the new hip. Aren't second replacements less effective as well?
Nutmegoreo - yep, that makes sense. Although that presumably isn't specific to the type of surgery as well, like weight loss is to hip/knee replacement, so why wouldn't they ask for any surgery? It makes sense to ask people to take measures to make treatment more successful though - it's normal to be asked not to eat before some things isn't it? And I'm sure there are plenty of drugs you're not supposed to mix with alcohol/etc.
I think the smoking one is for a broader range as the article indicated the joint surgeries as "such as".1 -
I would be interested to know what the protocol would be if the patient fails to meet pre-surgery requirements. I am absolutely against not performing needed procedures at all.3
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