NHS discovers new way to save money- refuse to treat people
The NHS is in a bit of trouble at the moment. What with Cameron and Clegg fiddling about with its innards, it is still under pressure to cut costs while maintaining service levels and keeping waiting lists down. Now, some Primary Care Trusts in England have developed their own criteria for who is, and is not allowed to have certain types of procedures on the NHS.
The two criteria currently being used are where patients are smokers or where they are obese. GPs magazine Pulse investigated all 91 PCTs and found that over a quarter (25) had introduced some new restrictions on care for smokers or the obese since April 2011, including 9 refusing to allow IVF treatment and eleven restricting hip and knee surgery. Other procedures now banned for some people include breast reconstruction/reduction surgery and open MRI scans.
NHS Hertfordshire is perhaps the most extreme case- last year it banned all hip and knee operations for patients with a BMI of 30 or more and required smokers to attend a smoking cessation course. Now, all routine/pre-planned operations are off the table for the fat and nicotine addicted, the only exceptions being cardiac, cancer and neurology surgery.
Other examples include NHS Bedfordshire, which now prevents obese patients from hip and knee surgery until after they have lost ‘10% of initial body weight or moved below BMI 35' while NHS North Essex requires patients to ‘have lost at least 5% weight and have maintained that 5% weight loss for at least six months'. In Devon and Cornwall, men and women must both have quit smoking for at least six months and also have a body mass index (BMI) of between 19 and 29.9 before they will be given certain fertility drugs.
Of course, the official line by the PCTs is that such patients will have a reduced chance of successful recovery from the operation, and in the case of hip and knee replacements, it could perhaps be conceded that reducing the weight stressor would improve the outcome, but is this the start of something more sinister?
Steve Nowottny, deputy editor of Pulse, said: "Rationing in the NHS is nothing new - but PCTs and clinical commissioning groups are increasingly taking the decision to ration care based on patients' lifestyle choices.
"In some cases there may be genuine clinical justification for rationing treatment on these grounds. But there is a growing suspicion that some PCTs are now blocking access to surgery for smokers and the obese simply to help achieve ever greater efficiency savings. Such a policy has disturbing implications - and GPs are increasingly uneasy about the NHS providing a second-class service to patients with less healthy lifestyles."
Dr Clare Gerada, chair of the Royal College of General Practitioners, described some of the restrictions, and particularly those for IVF, as ‘dreadful'."It's becoming the deserving and the undeserving. I think it's discriminatory and I find it astonishing. The Government should determine what should be applied universally," she said.
So what does the Government think? The Department of Health, which has overall responsibility for the NHS, told The Daily Telegraph “Blanket restrictions on procedures or minimum waiting times that do not take account of healthcare needs of patients are not acceptable. Decisions on treatments, including suitability for surgery, should be made by clinicians based on what is best for the patient.” So even the chaps in charge are not convinced this is a brilliant idea, even if they are still demanding PCTs reduce costs.
But are these policies even legal? Ben Troke, partner at Browne Jacobson LLP, cited s149 of the Equality Act 2010 and warned the restrictions would have to be carefully drafted “to avoid having any discriminatory effect… on any particular groups in society”. Like the fat smokers group.
But what do you think? Is this a legitimate way for the NHS to maximise its resources? Or is this the start of a slippery slope- if universal health care is denied to some, who will be next on the black list? The young being preferred to the middle aged, who won’t get as much ‘use’ out of surgery? Those with’ better’ jobs, like doctors or lawyers being preferred to labourers as, let’s face it, they are far more important? Disadvantaged/disabled/marginalised patients being treated before ‘non-minority’ patients to fill politically correct quotas? Sticky stuff.