In Hertfordshire plans have been drawn up by the NHS Trust to prevent those who smoke or who are obese from having surgery. Unless these individuals lose weight or quit smoking their right to have NHS funded surgery will be denied. This has caused a lot of controversy, particularly due to the arbitrary nature of which trust you fall into meaning your treatment could be entirely different through living on two adjacent roads.
Proponents of these measures claim this is finally asking patients to be responsible for their own health. Unless a surgery is considered urgent they will now be indefinitely not offered the surgery until they have lost the weight or quit smoking. This is similar to an earlier policy adopted by many Trusts whereby patients are offered delayed surgery, where the surgery is offered for three months in advance with the idea that they will make these lifestyle changes in the mean time. This has had some level of success, particularly when the patient has been clearly informed of the risks of the surgery at a higher weight for example, but often, the lack of genuine incentive means that people only lose insufficient amounts or nothing at all.
The Trusts, East and North Hertfordshire CCG and Herts Valley, have said their plans are to encourage patients to “take more responsibility for their own health and wellbeing, wherever possible, freeing up limited NHS resources for priority treatment”. Some critics believe that this measure has not been introduced in the best interests of the patients but rather due to the financial difficulties both find themselves in. Between them they need to save £68 million this financial year, and this measure may have been thought up purely as a response to this.
The implications of this system being introduced are largely not entirely favourable. The NHS was founded on the principle of equality of access to healthcare, and so this idea, particularly when only rolled out to two Trusts, goes against this. Equally, we must consider the impact this has on the medical wellbeing of individuals. Clinical guidelines exist for a reason, that reason being because of the results it provides, and so straying from this guideline could lead to substandard care. It is not acceptable to leave patients in pain and discomfort for potentially long time periods, and doing so may cause worse outcomes after surgery. The mobility that may be lost by individuals due to the amount of pain they are in may in turn make it harder to make these positive lifestyle changes, and may mean that even after the surgery they cannot get back to a normal life.
Michael van der Watt, the West Hertford Hospital Trust Medical Director, has strongly opposed the proposal, stating, “There is a wealth of evidence that does not support the theory that worse outcomes occur in patients with a BMI greater than 30”. This proposal seems to have been made without consideration of the medical implications of the new proposal, and only considering the money and time saving benefits.
However, patients must take responsibility for their own health as far is it is possible and actually understanding the impact their lifestyle choices have on their health is the first step. Whilst there may not be great evidence that having a BMI under 30 leads to better clinical outcomes, it often can help prevent the problem from occurring or worsening in the meantime. Whilst it is may be too late for lifestyle changes to help with the problem they are presenting with, it could help them for having later reoccurrences or other related or unrelated issues arising. The NHS, whilst always based on the equality of access to healthcare, is not simply there to make up for the poor life choices we make, and it might seem only fair that as the demand for emergency operations increases that proposals are suggested to try and ease the demand.
Ultimately however this proposals seems at least flawed, if not unfair. Firstly, people make choices every day which lead to them having to have emergency surgery, and this would not change under this proposal. It seems unfair that the only two lifestyle choices to come under pressure would be weight and smoking related. Equally, whilst this offers exceptions for those who have “exceptional circumstances” this is not enough. It would likely not be considered that someone who has struggled with their weight all their life as having exceptional circumstances. Or that someone who is depressed and therefore has little motivation to lose weight. By having a blanket policy there leaves little room for consideration of an individual’s circumstances and that is really the purpose of treatment – to aid the individual. Whether this proposal is ultimately rolled out or not is yet to be seen, but it is likely to attract further criticism in its current form.