NHS discovers new way to save money- refuse to treat people

7 March 2012

surgeonThe 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.

TOPICS:   Health


  • Zleet
    What did everyone expect? Cameron and co come in swinging sledgehammers then complain about the state of the place and that they have some 'friends' who could repair it at a 'reasonable' cost. Situations like this, caused by the coalition, will no doubt be used as justifications for more meddling and attempts to force through unwanted 'reforms'.
  • David
    I think it's perfectly fair to introduce restrictions, but I agree that such restructions should be universal. Alcoholics don't get a liver transplant, so smokers shouldn't get a lung transplant and horrifically obese people shouldn't get joint replacements that they wont properly recover from. The only part of this I don't like is the postcode lottery that it introduces.
  • PokeHimPete
    Im with David, however I think that obese people should be shot (along with chav families who haven't done a days work in their lives).
  • The B.
    Thank goodness I have PMI.
  • Michael
    I don't think that is anything wrong, in theory, with saying that if you want the state to look after you, you have a duty to keep yourself in good health wherever possible. As mentioned, the worry is actually how far these "criteria" go.
  • Victor B.
    I like the way PokeHimPete is thinking I have 10M rounds I need to get rid of. Might need some more for the lay abouts in this country though.
  • Gary
    Could be worse - there are a bunch of GPs near York who wrote to their patients saying certain services were no longer being funded by the PCT. They suggested using a private company for the treatments. The same GPs ran the aforementioned private company..........
  • Dick
    Obese people should be rendered down into dog food. And all the oil recovered in the process could be used to fuel cars. It is an environmental win on three fronts: a readily available source of fuel, less food needs to be grown and we don't need to see the fat fucks.
  • Ali
    I understand not giving smokers lung transplants or something actuarlly related to smoking, but is there a reason (other than cash) that they shouldn't get say their appendix taken out?
  • Mary H.
    They could save a 'shit-load' if they stopped treating seriously ill children and trying to keep them alive. These little shits must cost the country a fucking fortune, not only short term, but long term, directly and indirectly, plus we won't have to endure the ubiquitous Children In Need bullshit that serves only to line the pockets of those involved.
  • Al
    @Mary Hinge - I think you might be onto something here. I don't see why I should have to pay for people who go outside ... it's their own choice. I choose to stay in my basement and, apart from trench foot, I've yet to have an injury that requires medical treatment. Child? No treatment. Old? No treatment. Between child and old but have an illness? You weren't taking care of yourself so no treatment.
  • Capability B.
    Well they paid for my operation to change me into a lady. The Real Bob, do you mean PMT when you say PMI, because as a lady I too am concerned with this matter.
  • Elliot
    The NHS peddle two types of smoking cessation techniques. Champix/Zyban and Nicotine Replacement Therapy [NRT], patches, gum and inhalers etc. They are both extremely expensive and have a poor success rate, NRT especially; why wouldn't it? Treating people with nicotime to get them off their nicotine addication - You do the math. Cold turkey works and is free by comparison and there are loads of books the NHS could endorse or even give away for very little. I chose the mygismo method - cheap and healthy. Hey I'm a non smoker now so i'm one of the annoying ones preaching about the joys of being a non-smoker. Laughing all the way to the bank!
  • Frank P.
    I think bringing in a scheme where free operations and treatment should be offered to everyone that needs it on the NHS should be introduced but with a slight difference . Letters should be sent out to invite these people to there local Hospital for them to receive there ops/treatment all on the same day, whether they are smokers, fat, old or young. Once through the doors they should be led into a room one by one and given some kind of injection (like what a dog has when it goes to doggy heaven) The hospitals can then put these lifeless bodies into some kind of furnace to heat and power our homes or as Dick said power cars. Some could be used as fertiliser on fields also. This would allow the NHS to recover sufficiently for a period of time, saving a fortune and would also serve as a warning to people becoming ill wanting operations in the future.
  • captain c.
    As someone suffering from a chronic illness that could possibly been cured if they hadnt delayed diagnosis for nearly 10 years by claiming my constant weight gain was down to me being fat (doh!), I find all your joky comments offensive. Please send them to Private Eye, so everyone can enjoy them. PS. Telling me to lose weight was a bit rich, coming as it did from a doctor who was fatter than me, he could easily have been a contestant on "The Biggest Loser"
  • Top M.
    Thank you for the auspicious writeup. It in truth was once a entertainment account it. Look complicated to far added agreeable from you! By the way, how can we be in contact?

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