Tubby, Or Not Tubby: Fat Is The Question

About the NHS

"Since its launch in 1948, the NHS has grown to become the world's largest publicly funded health service.  It is also one of the most *efficient, most egalitarian and most comprehensive.  *(Erm, this can't be right – thinking of the present Health and Social Care Bill and the reasoning behind it?)

The NHS was born out of a long-held ideal that good healthcare should be available to all, regardless of wealth.   That principle remains at its core.   With the exception of charges for some prescriptions and optical and dental services, the NHS remains free at the point of use for anyone who is resident in the UK.  That is currently more than 60m people.  It covers everything from antenatal screening and routine treatment for coughs and colds to open heart surgery, accident and emergency treatment and end-of-life care."

The above can be read at NHS Choices.

Of course good healthcare is no longer available to all – some excluded from elective surgery in specific health care trusts (e.g. Kent, North Yorkshire) as they are smokers or/and are obese.  It is true that all surgery involves risk and this risk is said to be increased in those who smoke or are obese.

Research would suggest that smokers have a higher incidence of postoperative lung problems caused by increased mucous production and decreased ability to clear it.  A smoker's blood is less oxygenated (through inhalation of carbon monoxide and nicotine) and blood flow to the wound is reduced, increasing healing time and the risk of infection.  Giving up the weed a few weeks before surgery does appear to be beneficial.      (On a personal note and as a smoker I can state that my habit has never appeared to have a detrimental effect after surgery – but maybe I am lucky?)

The obese - research here shows that surgery is more complicated in that incisions have to be deeper and  surgery takes longer and is therefore more expensive.  Post operative complications centred round longer healing time – due to a decreased blood supply to the wound and an increased risk of nosocomial (hospital acquired) infection, particularly surgical site infection and that morbidity – not mortality – is increased after surgery.

However, and this is a big however – no pun intended – research here and here show that "… withholding surgery based on the BMI is not justified" and "The regressive attitude towards general surgery in obese patients is no longer justified."

Interestingly, if you read here you will see that bariatric surgery on those with a BMI of 30 or more "appears to be a clinically effective and cost-effective for moderately to severely obese people compared with non-surgical interventions."  This will be a poser for some NHS trusts then – can't have surgery with a BMI above thirty – so you lose a little weight and then no longer qualify for bariatric surgery!  How frustrating that will be!

If you read this article in Pulse you will read that (some) GPs have decided that it is okay for those who are obese and/or smoke to be discriminated against and are backing NHS Hertfordshire to block same denormalised, stigmatised individuals from elective surgery unless certain conditions are met.   So the right to healthcare is no longer available to all and this principle (no longer) remains at its core then?

You will see from the comments in the above mentioned article that all GPs do not condone the rise and rise of the 'Health Police' and indeed this criminalisation of the obese and the smoker is not new.   Poor GPs will also get it in the neck regarding (none) referrals for other newly specified (none) treatments as PCTs add more procedures to the list of 'low clinical priority.'  These measures are of course implemented in cost cutting exercises as trusts need to tighten their financial belts. 

If you visit here - Page 16 (pdf), you will see the Croydon list of low priority treatments.  I find it a little worrying as without one of those specified procedures – I am a 100% certain that I would have been 'on the sick' for over twelve years as I certainly, certainly would have had a greatly reduced quality of life.  It is a sure bet that those folk that made up this little list have never experienced some of these conditions.

So there you have it folks – the NHS is being slowly privatised – believe me it is (!) – and patients are already being selected out of the assurance of 'good healthcare … (being) available to all' and the 'core principle' is no longer the core principle and as you were warned here, there and everywhere in blogland, GP mags and indeed The Guardian the NHS as we knew it is slowly but surely becoming a distant memory.

You were warned…

I wonder why sports injuries aren't excluded from treatment…? 

Competing interests:  I smoke and am overweight although not obese and I just love my imperfect NHS.

Anna :o]