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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: 211
Replies to This Discussion
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Permalink Reply by Julie on
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Not sure about this but is it not the case that we receive treatment abroad which is paid by our NHS because of huge waiting lists due to the pressure on the NHS by the number of people needing treatment. If we received treatment abroad is it not either paid by the NHS of by private insurance/holiday insurance? I know that in Europe we are meant to receive the equivalent of NHS treatment but when my Mum was unwell abroad and had to be taken to hospital the first thing they asked for was insurance documentation. When they mentioned the "European health insurance card" they were told no it had to be insurance. Maybe it depends on what hospital you are taken to?
Re no NHS treatment for obese or smokers, this is most definitely discrimination and just shouldn't be allowed full stop no matter what your situation. Next thing you know it'll be no treatment on the NHS for bald, one eyed, toothless person LOL and then it'll be no free treatment to anyone, you must have private insurance only!
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Permalink Reply by Rosemary Kemp on
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Thank you Tigers! We need to be careful about becoming racist. Just a little comment about exercising when our joints are shot to pieces. When I started on the cross trainer, my knees just couldn't cope at all. I had trouble getting up onto it and then using it and then getting off of the blinking thing and then I couldn't walk because my knees were in such trouble. A year later and I have developed muscles around my dodgy knees and can do the 15 minutes I spoke of and even walk once I get off! I still struggle climbing up onto it though and getting off I do slowly. As long as you take it very slowly and start with low impact exercise (my gym people are fantastic and they help me loads!) you can do it. At first I thought everyone would gawp at me and think I was pathetic and huge but they really don't. They are all self obsessed and concentrate on themselves. Now I'm definitley not the worst one there! The first diabetic nurse and first dietician I saw were hopeless and I felt like you but then I met a great dietician and she has really supported me. It's down to individuals but it is worth having a go! Good luick to you! Rosemary
Tigers Fan said: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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Aren't holiday/traveling issues different from immigration issues? Here in the states we will not deny any visitor medical treatment regardless of insurance. Our problem here is that we have people coming up from Central and South America abusing our system and driving up rates and time for everyone else. I assumed the problems mentioned were much the same. Maybe I interpretted wrong?
Tigers Fan said:
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 Tigers Fan on
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Hi Rock
Without wishing to start a political debate in a CPAP forum: the US immigration problem and the UK problem are different. Because UK tried to rule the world a few decades ago, we have lots of people from the "commonwealth" (independant ex-colonial countries) who were invited here during labout shortages, have a moral and legal right to be here, who have even more 'dependants'. We also belong to the European Union which guarantess freedom of movement for labour - and thus the right of abode. Add to this mix an Immigration Department (Border Control) that is underfunded and guided by politically motivated convenience.Add to that a huge 'do good' native population who seem to believe UK can give succour to the world and its family. Add to that straight out illegal immigration as you have in the States. Now, divide the native population into two unequal parts, one of which says immigarants take our jobs and generally don't loike foreigners and the other part which believes immigration brings us wealth and prosperity - and includes the do-gooders.
Given that as a basic explanation of the situation, can you really expect to interpret correctly?
Added to which, folk in the UK are as adamant about keeping free medicine and the NHS as you guys are adamant about not wanting government lead medicine AND as we are very proud of our clanking, creaking NHS, you may see that opinions about excluding the "undeserving" to save costs and keep the NHS going can get extreme.If an individual perceives that his/her share of treatment is not available because of the cost of treating a foreigner (here legally or otherwise) - well - watch out!
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Permalink Reply by Kath Hope on
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Putting all of the other issues aside that have arisen due to my original post, the point I was making regarding Sleep Apnoea being a low priority to treat, is that people are still under the illusion that treating OSA is only about helping people feel less tired, rather than the treatment, hopefully, stopping sufferers getting affected by the other 'conditions' we on here know it is linked with (heart attacks, strokes, diabetes, thyroid issues etc.). Someone I was speaking to yesterday who's new to CPAP (and now feeling on top of the world) also pointed out that when people are sleep deprived and constantly tired, this feels like an illness in itself! Therefore, OSA should not be low priority and the UK needs to realize this!
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Here here Kath! The main point of this discussion was OSA not being taken seriously enough. Having said that, of course politics and different perspectives affect interpretations (Tigers Fan has explained it very well. We're all sensitive about our views!)
Having just come back from the sleep clinic and having had to spend a fortune of my own money to get an automatic apap machine (my choice to make my sleep time quieter and less of a continuous hurricane) I feel a bit jaded but they have also given me a brand new cpap machine. Personally, I don't really think I can complain. Once they start restricting who is allowed to be helped it may not feel quite so great!
I'm just so relieved that the specialists aren't pressuring me to have the gastric band operation any more. I really believe that surgery should be avoided whenever possible. I've had enough of that during my life and this was one I was able to avoid by being strong minded re the diet, aided by the OSA treatment.
(There - I've muddled the two forum posts up for you!) Rosemary
Kath Hope said:Putting all of the other issues aside that have arisen due to my original post, the point I was making regarding Sleep Apnoea being a low priority to treat, is that people are still under the illusion that treating OSA is only about helping people feel less tired, rather than the treatment, hopefully, stopping sufferers getting affected by the other 'conditions' we on here know it is linked with (heart attacks, strokes, diabetes, thyroid issues etc.). Someone I was speaking to yesterday who's new to CPAP (and now feeling on top of the world) also pointed out that when people are sleep deprived and constantly tired, this feels like an illness in itself! Therefore, OSA should not be low priority and the UK needs to realize this!
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See Kath you shouldn't have mention all the other procedures being added to the low priority list LOL, there's nothing like a good old NHS discussion to liven things up a bit :) The list was probably written by someone who knows nothing about SA so hopefully someone will put them right.
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I think our problems are more similar than you might believe. LOL! Thanks for the explanation TF. No debate here. It is truly amazing to see how two completely different systems deal with the same problems.
Tigers Fan said:Hi Rock
Without wishing to start a political debate in a CPAP forum: the US immigration problem and the UK problem are different. Because UK tried to rule the world a few decades ago, we have lots of people from the "commonwealth" (independant ex-colonial countries) who were invited here during labout shortages, have a moral and legal right to be here, who have even more 'dependants'. We also belong to the European Union which guarantess freedom of movement for labour - and thus the right of abode. Add to this mix an Immigration Department (Border Control) that is underfunded and guided by politically motivated convenience.Add to that a huge 'do good' native population who seem to believe UK can give succour to the world and its family. Add to that straight out illegal immigration as you have in the States. Now, divide the native population into two unequal parts, one of which says immigarants take our jobs and generally don't loike foreigners and the other part which believes immigration brings us wealth and prosperity - and includes the do-gooders.
Given that as a basic explanation of the situation, can you really expect to interpret correctly?
Added to which, folk in the UK are as adamant about keeping free medicine and the NHS as you guys are adamant about not wanting government lead medicine AND as we are very proud of our clanking, creaking NHS, you may see that opinions about excluding the "undeserving" to save costs and keep the NHS going can get extreme.If an individual perceives that his/her share of treatment is not available because of the cost of treating a foreigner (here legally or otherwise) - well - watch out!
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Permalink Reply by Jackie on
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Oh my goodness ... yes the NHS needs to get its house in order and the amount of monies wasted is shocking but I do know that to deny someone treatment for OSA or even the diagnosis is disgusting - Warrington is not far from me and no doubt this insanity will spread ... St Helens pct does not have a sleep clinic at all and I am under another pct for treatment.
The NHS employs terrible management, most of whom may have been excellent clinicians, but haven't a clue to good management. I know from personal experience just how many terrible managers there are and the salaries they rob from the NHS. If they were to get rid of 2/3rds of managers they would save a lot of money ... it is the other staff who do the work anyway ...
I am overweight, very much so, I have several disabilities, all of which apart from my tumour and the OSA began when I was so called slim and 'fit' ... my energy is limited and I struggle with motivation for most things .... a viscious circle. I have seen dieticians and had depression and stress management (all of which when I was more mobile and still working) - I know what I should be doing ... but the reality is a struggle. The easy way is less trouble and less stressful but is not the right way ...
I can't even have an operation for my tumour, so any weight loss surgery is out too ... yet again another circle for me and I know I am not helping myself and this piles up the depression ...
If I had not been diagnosed and treated with the OSA then I know by now I would surely have done something extremely stupid out of desparation, if I was still alive that is to do it ...
Life without CPAP is no life at all, bad as I am most of the time, CPAP has made a huge difference to my life.
The people who put OSA on this list no doubt know nothing about it. The specialist I saw did not have a go at me over my weight and I really expected him to say 'go away and lose 6 stone to cure yourself' - but he didn't. He said some weight loss would probably help lessen the number of events, but there was no real cure, only ongoing treatment.
Another lady I met at the hospital, was most distressed as her consultant had said she was fat and to lose weight and it would go away .... I looked at her lovely figure in amazement ....
sorry I am rambling ... sleep apnoea is under funded almost everywhere ... and to deny people life saving treatment and also a treatment that can turn a persons life around is disgusting ...
soon the nhs will have no money as people begin suing them for denying them human rights ...
or does human rights only protect the wrong people??
If a grossly overweight man was in prison and denied treatment there would be such an outcry .... (though personally I think if you comit a crime you forfeit your rights)
It is time the government got their act together on the basics. Stop people flooding our country and properly charge people who are not British.
I know you can get free EMERGENCY treatment in Europe with your card ... they may not turn you away without proper insurance or the means to pay in a lot of cases, but they will give you a huge bill and expect payment. Dead or Alive !
I can no longer get health insurance to travel abroad even in europe and USA was out of the question for just cost wise a few years ago .... (wish I was fit enough to travel ...)
Maybe it is time that we should have to present our NHS health cards to receive free treatment at home ... or pay a bill ...
Jax xxx
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