Monday, 25 July 2011

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]


Jinksy said...

With a fast moving NHS service, I'd probably be dead by now, from an allergic reaction - though admittedly, this was caused by a pill prescribed by the NHS! LOL ♥

Health Online said...

Speaking with a doctor is lot more easier .

Dave King said...

It's easy to grumble about what we'v e got - how ever good it is. More to the point is what we're about to get.

HyperCRYPTICal said...

Thanks for your kind comments folks.

Jinksy ~ glad you're not dead my friend - what a miss you would be!

Health Online ~ well, yes? Interesting site.

Dave ~ I don't think we'll get very much! Very worrying - be afraid, very afraid.

Anna :o]

NorthernTeacher said...

Hiya, Anna

I, too, love the NHS but, touch wood, I very rarely have to use it and hopefully this will continue to be the case. My parents and in-laws are very frequent users (all 75 - 85) and seem to get very good service and care (recent hospitalisations included). If they couldn't get what they needed, they certainly couldn't afford to go private.

Access to good healthcare is such a part of our psyche in the UK that it is generally unbelievable that this might be changing. I am sure that's why the general public seem a bit apathetic about it, and I am afraid that that probably includes me.

I worked in China for several years and they have to pay for all medical services. The thing is there that certainly the people I knew went to the doctor for absolutely everything. They had to pay to see a doctor and always always expected a prescription. No money, no healthcare. They thought I was very healthy (I am) but were desperate to take me to a doctor if ever I sniffed or sneezed. They just couldn't understand my belief in the body taking care of itself. One story that I will never forget happened when I was actually teaching. A student (adult female) said she had to phone the hospital (no GP surgeries there, all doctors work in hospitals) because she had water in her ear from her shower. I just gawped at her and asked if she hadn't tried just using a cotton bud or even just moving her head from side to side. No, it was serious, she was sure, and expected the doctor to sort it out. I always thought that part of the Chinese psyche is if you have to pay, then it will work!

What am I trying to say? Lost my thread a bit but in some ways here we expect perfection for nothing. I like it that way but I'm not sure it's the right thing in the long run. What really bugs me is the call from the politicians/government that we (the pubic) want more choice/must have more choice. What do they mean by choice? I just want to be able to go to the local doctor and get sorted and I expect many others feel the same.

HyperCRYPTICal said...

Sorry for the delay in reply NT - been away on holiday!

Interesting story re China!

I think the problem lies in the belief that we receive free health care - we pay for our healthcare indirectly in taxes, etc. Nevertheless the sense of (its) 'freeness' makes us complacent.

'Choice' is a clever illusion - we will have less choice. The list of low priority treatments, including elective surgery will grow - we will have less and less choice.

If I have a medical condition requiring a referral - I want my GP to refer me to a consultant he knows and trusts. I have no idea who the best consultant is and therefore cannot chose on this basis - only on the nearest hospital or the earliest appointment - which probably will not find me the best consultant.

Privatisation will provide even less choice - companies will cherry pick. The old and the chronically ill or those with an 'expensive to treat' condition will fall by the wayside. They will have no choice in the matter.

Ramble, rant!

Anna :o]

NorthernTeacher said...

Hi again

Hope you had a brilliant holiday!

Yes, you are right and put into words exactly what I wanted to say. Rant away!

Randy said...

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