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NHS Warrington to Limit Treatment for Sleep Apnoea! How many others will follow suit?
GPs agree ban on operations for smokers and obese patients
19 Jul 2011
Exclusive GPs have signed off a series of sweeping referral restrictions by NHS managers that will bar smokers and overweight patients from being referred for surgery, as PCTs across the country bring in new cost-saving restrictions.
Both LMCs and GP consortium leaders have backed moves by NHS Hertfordshire to block any patient with a BMI over 30 from being referred for routine joint replacement surgery without first being referred to a weight management scheme. GPs will also be prevented from referring smokers for any orthopaedic surgery until they have been referred for smoking cessation.
GPC leaders are seeking legal advice on the controversial plans and are warning that a number of trusts across England have suggested they may follow suit. Locally, the move has driven a wedge between GPs – with consortium leaders divided over the ethics of the restrictions and Hertfordshire LMC backing the plans by just one vote.
Meanwhile, a Pulse investigation covering 41 PCTs has found two-thirds have added new procedures to ‘low clinical priority' lists since April, as trusts struggle to cut costs.
Procedures subject to new restrictions include the treatment of ganglions in Hampshire and DEXA scanning in primary prevention of osteoporotic fractures in men and women over 50 in Bristol. NHS Warrington has added 13 restrictions, including the treatment of obstructive sleep apnoea.
But it is the restrictions on treatment for smokers and obese patients that have prompted fiercest debate.
Dr Tony Kostick, joint chair of NHS Hertfordshire's clinical executive committee and chair of East & North Herts GP Commissioning Consortium, insisted the move was based on ‘sound' clinical evidence.
He said: ‘It's divisive in the sense some GPs don't want to confront the rationing debate. We spend fortunes on treatments of limited clinical value.'
A spokesperson for NHS Hertfordshire said the changes had been legally approved, and were necessary to ‘make absolutely the best use of NHS resources'.
But Dr Mike Ingram, chair of the single-practice Red House Consortium and a member of Hertfordshire LMC, said: ‘Patients' access to services should be based on the care they require and not on a discriminatory policy. I'm very worried about denying people care on the basis they are fat.'
Dr Nigel Watson, chief executive of Wessex LMCs and chair of the GPC's commissioning and service development subcommittee, said he was discussing the restrictions with the BMA's legal department.
‘My understanding is you cannot discriminate against patients on the basis of lifestyle choices,' he said.
Clinical procedures being added to low-priority lists
- Acne scarring treatment
- Cataracts
- DEXA scanning in primary prevention of osteoporotic fragility fractures in women and men over 50 years
- Dose-dense temozolomide in recurrent glioblastoma multiforme
- Hip replacement
- Knee replacement
- Treatment of ganglions
- Treatment of obstructive sleep apnoea
- Ultrasound to promote bone fracture healing
Views: 210
Replies to This Discussion
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Permalink Reply by Kath Hope on
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This is very worrying regarding sleep apnoea. Just as we're getting the UK "Awake" to the seriousness of untreated sleep apnoea, we read about Warrington putting it on their low priority list. Here in Hull we've heard our Sleep Clinic is going under review.
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Permalink Reply by Tigers Fan on
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I don't even know what some items on the list are! but hip and knee replacements along with cataract treatment affect anyone - no lifestyle choices involved. OSA is not lifestyle dependent for many people.
Any blanket discrimination is going to catch the 'innocent' as well as those who have caused self-inflicted damage (like me). Let's face it, they could save much more money by not treating drunks, motorists and pregnant women - or even more by making redundant the layer upon layer of management that actually achieves nothing but the continuation of the bureaucracy.
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Permalink Reply by Katrina Wray on
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Hmmmm - people with genuine problems (knees, hips, cataracts, OSA) are possibly going to suffer, yet people can come to this country from anywhere else and take full advantage of the NHS for free. Fair? NOT!
Off my soapbox now . . . . . . . . . off to cool down.
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How can something that kills you be low priority. If it prevents high blood pressure, heart attacks, strokes when treated, why stop treatment. I live in Herts...I'm going to speak to my GP and my MP!
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Exactly my point Graeme, and the main reason I believe they're picking on OSA is because they're still not grasping the fact that untreated OSA can lead to many other 'conditions' such as heart attacks and strokes, which will cost the NHS far more money in the longrun. Let us know how you get on with your GP + MP. I'm going to fight my corner too here in Hull, where we have a fantastic Sleep Department. Nobody will ever take away my treatment from me!
Graeme Simpson said:
How can something that kills you be low priority. If it prevents high blood pressure, heart attacks, strokes when treated, why stop treatment. I live in Herts...I'm going to speak to my GP and my MP!
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Too true TF. Even when lifestyle choices are to blame, this is often a knock-on effect of deeper problems in people.
Tigers Fan said:
I don't even know what some items on the list are! but hip and knee replacements along with cataract treatment affect anyone - no lifestyle choices involved. OSA is not lifestyle dependent for many people.
Any blanket discrimination is going to catch the 'innocent' as well as those who have caused self-inflicted damage (like me). Let's face it, they could save much more money by not treating drunks, motorists and pregnant women - or even more by making redundant the layer upon layer of management that actually achieves nothing but the continuation of the bureaucracy.
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Totally agree Katrina. Hope you've cooled down now. I'm still stood on my soap box ;)
Katrina Wray said:
Hmmmm - people with genuine problems (knees, hips, cataracts, OSA) are possibly going to suffer, yet people can come to this country from anywhere else and take full advantage of the NHS for free. Fair? NOT!
Off my soapbox now . . . . . . . . . off to cool down.
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Permalink Reply by Julie on
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I'm with you Katrina!!! We have some weird rules in this country regarding who can have what. It's about time the UK came out of the human rights agreement and the MPs/MSPs listened to the public. I'm thinking about 80% of people want the rules changes so that you only get treatment if you've lived in the country for a number of years and contributed towards the NHS. I think many folks in this country and too lethargic and just let change happen instead of standing up in groups and giving the MPs what for.
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Permalink Reply by Richard Mundy on
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This is the thin end of the wedge, I'm afraid, and really we only have ourselves to blame. The faults lie with an irresponsible immigration policy, where people from poor countries, with no skills to bring with them, can enter this country and immediately enjoy the same rights as a person who has paid his NI and taxes over many years.
The NHS hoovers up cash like there's no tomorrow, but the day of reckoning is getting closer, when stark choices will need to be made. It is a fanciful belief that the NHS can still be the panacea for all our ills, 'from the cradle to the grave'. This may have been true forty or fifty years ago, but times have changed. For one thing, there are many more cradles now, and not so many graves. To an extent, the NHS has become a victim of its own success, but along with enjoying the NHS ethic of free healthcare must go some responsibility.
We are each of us responsible for our own health; if we ignore our personal health issues and hope they'll go away, then we cannot complain when, after years spent avoiding healthcare, we are faced with a dilemma that ten years before could easily have been sorted out but now requires more drastic, and expensive, treatment.
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We need to read this policy suggestion carefully.
The suggestion is that people should be "referred to" smoking cessation and weight management schemes in order to receive medical help. If we understand this suggestion, they are not saying that we have to have stopped smoking or have lost a considerable amount of weight but have at least tried to address these problems seriously.
If our "lifestyle choice" is to deliberately not try to improve our health (not saying to succeed in improving our health) perhaps we should not be given expensive medical treatment that probably won't work. If we carry lots of excess weight, a knee replacement will not be a huge success. If we smoke, we aren't going to help our OSA. We all know that humans are weak but surely we need to be prepared to attempt to help ourselves?
If, however, this is just the beginning of something more sinister, (the truth?) that we judge fat people and smokers at face value and generalise (for example - all OSA sufferers are fat??? - definitely not the case - very simplistic view) then this is indeed a very scary prospect.
We also know that everyone is trying to cut costs at the moment; not least the NHS. All I know is that one unnamed specialist cancelled two appointments in a row with no notice whatsoever. I wonder if he treated his private patients like this! On the other side of the argument, there are a lot of fat people and smokers out there in denial. We need to accept that we have to take responsibility for our own actions and sometimes pay an unpleasant price. I just wish that it was easier to be sensible all the time and get it right more of the time!
Rosemary
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Based on the fact of the huge amount of support available for people who want to stop smoking, I came to believe that similar support would be available for people wanting to lose weight. Me and my logic! I was offered a visit with the Practice Nurse and/or a visit to see a Dietician. Tried both before with the same result - every visit results in yet more things to give up, stop eating, jog more. join a gym. A new Dietician with new ideas at each visit. Every time I have soon felt snowed under, smoothered and out of control - and stop visiting.
Bariatric surgery? I'm not fat enough! Go away and eat more, come back when your BMI is Blob high!
Now they are blaming being overweight for a variety of issues and refusing treatment. How can you exercise with buggered hips and knees? How much are you going to comfort eat with all the pain of worn-out joints?
As for not treating OSA - the resultant medical conditions have been enumerated in earlier posts - but no-one has mentioned the resultant road 'accident' costs to the NHS.
BY the by, let's beware becoming racist in our immigration remarks and let's remember reciprocal agreements that allow us to get treatment abroad.
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Permalink Reply by RockRpsgt on
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Nice to know that this is not just a problem in the states.
Katrina Wray said:Hmmmm - people with genuine problems (knees, hips, cataracts, OSA) are possibly going to suffer, yet people can come to this country from anywhere else and take full advantage of the NHS for free. Fair? NOT!
Off my soapbox now . . . . . . . . . off to cool down.
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