NHS may refuse to treat drinkers and smokers

[MistleToo]

news

first it's no new hips for the obese now this?

In the wake of George Best's death and a general feeling that he 'wasted' his new liver - what do you think?

so what about a diabetic who is not as careful as they could be over their blood sugar levels?

I think it works as Frogs mentions...

Diabetes is less cut-and-dried, though, isn't it? As far as I could work out, the recommendations only applied to particular procedures, rather than treatment generally. So I don't think there would be any question of a non-compliant diabetic getting chucked out of treatment.

I haven't read the whole thread, only the first few posts. think this is ridiculous.. there's no where to draw the line.

I smoke when I go out.. would I not get treated? so would I not have to pay NI? what if I got prgnant - would I get a midwife or a Health Visitor?

My nan smoked 40-60 a day, never had a day ill for as long as I can remember. She died peacfully in her own home from old age. If she'd had an illness should the NHS not have treated her? even though she started smoking before all the health risks were known??

Frogs - I think you are right. It must be over simplified as an exclusion policy such as what's being discussed here couldn't work.

With 12 million adult smokers in the UK they couldn't really justify calling it a NATIONAL health service anymore, and 12 million people are going to point out that other people endanger thier lives unnecessarily as well - as SA and others have pointed out.

I'm not particularly convinced that the government wants to banish smoking in the UK anyway. About 12 million adults in the UK smoke cigarettes and the government are raking in the taxes.

According to ASH:

Q. Smokers already pay more tax than it costs to treat smoking on the NHS.
A. This may be true - tobacco taxation raises revenue of £9.5bn [i] compared with the £1.7bn needed to treat smoking-related illness[ii]. However, this comparison is not particularly valid. Tobacco tax is not intended to be a down-payment of the cost to the NHS of dealing with smoking-related illness. There are two main reasons why UK taxes on tobacco are relatively high: a price incentive to persuade people to give up, and to raise taxes from a source which has relatively little effect on the economy.

MoH if you read my post below, this refers only to known lifestyle risks that affect the outcomes of specific procedures. No-one's talking about smokers not being entitled to ante-natal care, for heaven's sake.

Taxes on smoking raise £8bn a year, according to the Department of Health itself (the public health minister confirmed this to me at a press conference). So Gordon Brown would have a huge problem if every smoker stopped. That's more than twice the amount of the part of the British EU rebate that Tony Blair is being criticised for sacrificing.

I used to sit on a committee that recommends which drugs are recommended for NICE appraisals and I wasn't impressed by the quality of decision making, to be honest.

Jools, with regard to no new hips for obese - it's often the case that when these patients actually lose some weight before surgery they find they don't even need a new hip/knee after all! Just less load!

Someone might have already said that.

As mentioned below, they're not saying they won't treat people whose lifestyle has caused the problem, only where smoking/drinking/obesity renders the treatment ineffective.

So, a smoking asthmatic might not be given steroid treatment, because the smoking makes it ineffective.

An obese person might not be given a knee replacement because the chances of a successful outcome are reduced severely by the obesity.

Seems reasonable to me.

I agree with Frogs, the article is juat typical tabloid scare mongering with no substance - the 'may' in the headline is a dead givaway. It may as well have been NHS may refuse to treat some of us in years to come..on the other hand they may not..

I don't understand this thing about being suddenly deserving of basic human rights. George Best wasn't rubbing his hands with glee when he go a new liver was he, he was a struggling alcoholic, he struggled again, he failed and he payed for it with his life. And why should smokers loose out - why not get the tobacco corps pay up instead?

Forgs - first off I don't think there was any need for the 'heaves sake'. Secondly, I genuine don't believe there is a sensible place where the line could be drawn so was making an exaggerated point.

There's just no point wasting money on treatment that won't do any good.

And there's nothing wrong with encouraging patients to be more healthy. That's just good medical practice.

Agree, tortoiseshell but teh article is trying to say people will be refused on the basis of their lifestyle choices not their overall health.

If this becomes policy anytime soon I think it is a travesty. I'm hoping this is just something to think about for the future, once the generations of NHS users who had virtually NO information about how smoking/drinking/poor diet affected health have passed on.

At the moment I feel the result would be a two-tier system with the lower income groups - who, let's face it, are more likely to smoke etc. - unable to access healthcare which will all go to the relatively affluent.

Although I know inequity still exists in this country, I don't want it perpetuated by the very bodies designed to do away with it.

The FGS wasn't aimed at you, MoH, so much as the media reporting, which seems to be based on the principle of, "Now, what's the most sensational slant we can give this story...?"

BBC version of story here

"Poor lifestyle 'a factor in care'"
"treatment should not be denied because their condition was self-induced."

"The report says that NICE should avoid discriminating against patients with conditions such as diabetes which may be linked to factors such as over-eating.

However, it says that if continuation of the poor lifestyle is likely to influence the outcome of a particular treatment, then it may be appropriate to take this into account in some circumstances.

For example, if an asthma patient smokes it can reduce the effectiveness of their steroid treatment. "

"He said: "No moral judgement is being made here. The bottom line is, does an individual benefit from treatment?

"And the issue with smoking, as with other lifestyle issues, is that you might not be able to benefit." "

my first gut reaction was, yeah. about bloody time too.

but
its just wrong imo. we do not have the moral high ground to choose who gets treatment and who doesnt. i dont smoke, think its a disgusting habit, but i dont like the idea of smokers not getting treatment. there is posh word for this but i cant think of it rightn ow.

Thanks for that clarification, tortoiseshell, it's making more sense to me now . I think for example it's a good idea for heavy smokers to be compulsorily referred to their GP practice's smoking clinic if they need ops.

I hope this whole thing about refusing hip replacements to obese people is not going to escalate, that's all.

ban production of cigarrettes.
the nhs will save lots of money

My understanding of the NICE comments is that doctors can decide to not treat patients 'if there is unlikely to be an improvement in the patient following treatment'.

So an example. Balloon angioplasty is known to help some people with angina. If people with angina smoke, the balloon angioplasty has little or no effect of their symproms. So why put patients through an invasive and expensive procedure if there is little or no benefit to the patient?

stitchintime - But would the NHS really save money considering the loss in taxes?

Another factor to consider is that smokers take a lot longer to heal from injuries...including surgical incisions.
And incidentally, during an interview the reporter asked George Best about his continued drinking after his transplant. His response? shrug of the shoulders "Well a new organ doesn't come with a set of rules does it?" Hmm...

This is an example of really poor reporting. The report in question is not guidance for the NHS, but guidance for groups developing NICE guidance. It is a 37 page document, and if you read it you can see how various experts have tried to think about the minefield of decision making in these circumstances. It was drawn up because of concerns about when a treatment should be recommended (important because some of the drugs etc are very expensive, and have very limited effects). This is what it says in regard to "self-inflicted" illnesses:
NICE and its advisory bodies should avoid denying care to patients with conditions that are, or may be, self-inflicted (in part or in whole). If, however, self-inflicted cause(s) of the condition influence the clinical or cost effectiveness of the use of an intervention, it may be appropriate to take this into account (section 5.5).
So not exactly what was reported! You can read it all (should you wish) here

What really riles me over this is that this suggests that overweight/smoking/drinking people will possibly be refused treatments. What about those overweight/smoking/drinking people that pay huge taxes & NI. There are lots of people in this country that do not contribute to society at all but if they are thin/non smoking/non drinking they would still benefit.

I still think that the NHS should be available for all.

Not, however for health tourists.