Herts GPs told not to refer obese patients for surgery (From Watford Observer)
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Lose weight - or your operation's cancelled
5:24pm Monday 9th January 2012 in News
By Adam Binnie, Senior Reporter
Herts GPs told not to refer obese patients for surgery
Overweight patients have been told to shift excess pounds before they are allowed operations such as hip and knee replacement, tonsil removal or gall bladder surgery.
It is hoped the new policy will result in patients being in a better state to recover following non-urgent procedures.
Today the Herts Valleys Clinical Commissioning Group held a conference about the scheme, which has been officially running since January 1.
Dr Nicolas Small, chairman of the group, said: “GPs in the area will not list patients for routine surgery until they have lost weight. There is a range of support, some from the GP surgery, or they can be sent to groups such as Rosemary Conley or Weight Watchers.”
Nationally, one in four adults is obese, and one in eight is severely overweight. Severely obese people can expect to die an average of eleven years earlier.
Now anybody with a body mass index of more than 35 will have to lost weight before they are eligible for non-urgent surgery.
A person of five feet and ten inches would need to be 17 stone and ten pounds to have a BMI of 35. A "healthy" BMI is between 20 and 25.
Dr Small said: “Surgery is more effective if people lose weight first and then surgery might not be needed at all. This is a trigger to help people lose weight.
“There is always a risk when patients are given an anaesthetic but there is strong clinical evidence that this risk is significantly higher when they are overweight.”
The group launched a similar scheme last year when overweight people wanting hip or knee surgery were told to lose weight before being listed.
An obese person is 15 times more likely to need a hip or knee operation and there were 5,000 of these replacements in West Hertfordshire last year.
Smokers will also have to agree to meet with a cessation advisor before being listed for surgery.
Rachel Joyce, consultant in public health, said: “Smoking and obesity are responsible for the vast majority of deaths in Hertfordshire.”
The Herts Valleys Clinical Commissioning Group, a consortium of GPs, will take over responsibility for buying health services when the country's Primary Care Trusts are scrapped in 2013. It covers about half of the county and will be responsible for Watford, Three Rivers and Hertsmere, as well as St Albans, Harpenden and Dacorum.
Dr Sheila Borkett-Jones, board member for Watford and Three Rivers, said: “It's a free country, but it's our job to inform people about living healthily.”
There is currently no plan to introduce a similar scheme for seriously underweight patients who are waiting for routine surgery.
Dr Borkett-Jones added: “We don't suffer from an epidemic of people who are underweight.”
Comments(53)
Toshhorn
says...
5:57pm Mon 9 Jan 12
I AM OBESE (ONLY HAPPENED OVER THE LAST 5 YEARS) AND HAVE PAID NATIONAL INSURANCE FOR OVER 35 YEARS. I CANNOT PHYSICALLY GO DOWN THE GYM ANY MORE BECAUSE OF ARTHRITIS IN MY BACK, NECK AND KNEES. I STILL GO TO WORK EVERY DAY AND PAY MY TAX AND NATIONAL INSURANCE, I played lots of sports up until my mid forties but now, no matter how much I diet and refrane from alcohol , I really struggle to keep my weight under 16 stone.
LSC
says...
7:37pm Mon 9 Jan 12
I am not obese, but I am a smoker. A tax paying, law abiding smoker.
The NHS will treat the low-lifes who go out for a drink and a fight on the weekend. Picking a fight on a Saturday night and getting your nose broken is far more a deliberate choice than gradually gaining weight over 50 years.
Skateboarding is dangerous, but far easier to give up than smoking. So should we refuse skateboarders treatment? We all know falling off one can result in broken bones, and nobody HAS to use one, so what is the difference?
It is common knowledge that riding a motorbike is a lot more dangerous than driving a car, which in turn is more dangerous than just staying at home. Are we going to have a league table of such things?
Will I earn NHS 'points' and go to the front of the queue for my ruptured appendix because I can prove I had muesli for breakfast and have never tried Sky-diving?
Shameful.
The law of this land says I can spend my time juggling chainsaws if I want to. And if i cut my arm off doing so, I get an ambulance, not Big Brother telling me it was my own fault.
Hornets number 12 fan
says...
9:01pm Mon 9 Jan 12
onlyonerodthomas
says...
9:55pm Mon 9 Jan 12
WatfordAlex
says...
10:02pm Mon 9 Jan 12
Hornets number 12 fan
says...
11:19pm Mon 9 Jan 12
WatfordAlex wrote:And that was a party political briadcast on behalf of the I'm alright Jack party!
Seems sensible enough. There is a limited supply of surgery places and too much demand (partly due to the obesity epidemic). If you have to ration the supply of surgery places, then it makes sense to give them to people who are demonstrating that they are doing something to make themselves better. Anyway, the unhealthy people will still get surgery, but they will just have to wait longer (it is non-emergency surgery after all). The skateboarding anecdote is a red herring - you can go skateboarding and not injure yourself. However, smoking or eating mountains of calorific food will make you less healthy full stop.
Toshhorn
says...
9:22am Tue 10 Jan 12
She always tries to get me to the doctor, but what's the point? they will only treat us obese people as and when we become urgent cases.
Sorry to be such a burden, but I honestly can't understand why I can't be treated.Message to all fat people, stay away from the doctors, they don't want to treat you, nice message.
phall lover
says...
9:47am Tue 10 Jan 12
Im doing it .And avoid Iceland.
garston tony
says...
2:37pm Tue 10 Jan 12
This is entirely about the health and wellfare of the patient, either because the operation and recover is possibly going to go better or because the need for an operation may go away.
garston tony
says...
2:38pm Tue 10 Jan 12
So to take cameluk's comment, it is a free country and as a tax payer I am entitled to ask that my taxes are not wasted on avoidable proceedures and care or on people who continue in the lifestyle that got them into health difficulties in the first place!
Reader (R)
says...
4:28pm Tue 10 Jan 12
garston tony
says...
2:15pm Wed 11 Jan 12
WFTTWTFR
says...
5:53pm Wed 11 Jan 12
However, that's a wider debate. What gets me about this article is the patronising and sanctimonious tone that we've come to expect from doctors, e.g. "it's our job to inform people about living healthily". Well, no, actually, it's your job to justify your six-figure salaries by treating people. Eat a balanced diet, don't smoke, don't drink too much, take exercise - we get it, not sure a "cessation advisor" will add much.
And just to restate the point that others have already made, the chances of an obese person who is 15 times more likely to need a hip or knee operation losing weight looks a bit remote given exercise issues. If you're in that position, best move counties.
LSC
says...
11:51pm Wed 11 Jan 12
We all know that it is a bad idea for a young girl to be out alone at 3am, in a dark place, in a short skirt and silly shoes.
We know that is a bad idea. She knows it is a bad idea. She has been told by Mum, Dad, freinds, everyone. But she did it anyway, and then she got attacked.
Hands up who thinks the police would be right to say that because she didn't follow the obvious guidlines they are not going to bother investigating the case?
stuegs
says...
10:56am Thu 12 Jan 12
Obesity and smoking are two of the biggest drains on the NHS and are both self inflicted. So its about time the NHS used some sort of incentive to force people to help themselves.
They re not going to refuse giving urgent life saving treatment, so this is a perfect comprimise.
Its about time people stop making excuses for fat people. It is their fault they are fat, nothing else. They eat too much and dont do enough exercise, simple. Its about time being fat became as socially unacceptable as smoking.
AbbieSlimmingWorld
says...
12:27pm Thu 12 Jan 12
In our groups in Radlett, we find that most members have joined because of health-related issues and have had incredible success with reducing medication and even curing themselves of diabetes in some instances. Many have gone on to become physically active - even running marathons...
Our Slimming World Food plan is not a "Diet" but a healthy eating plan for life, and our groups give the most incredible support, not surprising then that local GP's are supportive of what we offer local patients. If all local residents were able to lose weight, our NHS would reduce some of the burden on its resources today and we would have a happier, healthier society.
Abbie, Slimming World Radlett,
Thursdays 5.30/7.30 Radlett Village Institute. Call 07917 794716
Toshhorn
says...
2:12pm Thu 12 Jan 12
I stopped smoking (ten years ago), put on the weight (I'm now just under 17st , 5ft11 ins tall and the Doctor said I was obese)and now can't excercise because of the above,
Constant knee, back and neck pain is driving me mad, but I still go to work everyday.
It's not nice struggling in this way and now there is no point me visiting a doctor for anything, because I am fat.
To all those in good health out there, look after yourselves.
To all us fatties, if you can't lose the weight, tough, just go away, nice caring people, I give up.
You can't be racist,sexist or ageist but it's ok to hate the fat people.
stuegs
says...
2:42pm Thu 12 Jan 12
Same for smokers. If you smoke you might get lung cancer, amoungst other things. No one forces people to smoke, its a choice they have made.
Same old stuff, people really should start taking responsibilities for their actions
Toshhorn
says...
4:23pm Thu 12 Jan 12
Herts GP
says...
10:14am Fri 13 Jan 12
In my opinion, we (the NHS) should not be penalising citizens who suffer an addiction like smoking. The debate on rationing operations in this way has been held over many years. A significant number of healthcare professionals (HCPs) do not condone witholding limb saving/life saving surgery from people who smoke.
Life is a lottery however you look at it. The imposition of rationing using measurable data should not be celebrated. Rather, we should be asking why there is not enough money and resources to treat all who need help.
garston tony
says...
12:05pm Fri 13 Jan 12
Surely it is right that the NHS focuses on prevention and such advise like this is along those lines. Not only does prevention save the NHS money in terms of having less to treat but more importantly it improves quality of life and indeed saves lives.
Is it something like 100,000 people die each year from smoking related illness and 30000 from illness related to being obese?
Im no medical expert but if someones illness can be improved by a change of diet and habit that must be better than surgery and a potential life time on pills?
And Toshorn I accept for some people their weight is something to a certain extent that is out of their control. But for many many many people it isnt, and neither is smoking, drinking and taking illegal drugs
LSC
says...
2:36pm Fri 13 Jan 12
If having a high BMI or smoking were illegal, I could begin to see the logic of this whole thing.
Surely a professional boxer, whose whole job requires being repeatedly hit very hard in the head should be put 'down the list' for NHS treatment too?
What about firemen, who keep running into burning buildings. They chose the job, knowing the risks, should they be secondary as well?
The whole thing in a free country is madness. If they ban smoking, then they can refuse me treatment for smoking related problems should I continue illegaly. But to take my duty on the cigs, my income tax and National Insurance then give me inferior service is simply morally wrong.
comments
says...
3:58pm Fri 13 Jan 12
However with the exception of obese people who have knee/hip problems...
it might actually be a good thing....It might push people to get healthy and stay healthy! ...
comments
says...
3:59pm Fri 13 Jan 12
Roy Stockdill
says...
6:53pm Fri 13 Jan 12
Already a great many people are living to be 100 and over, far more people are being told they will have to work until they are 75 before they will get a pension and far, far more people will need constant and expensive care when they get into their 80s and 90s?
The cost to the NHS of all this encouraging people to live more healthily and live longer will, in the longer term, actually cost a vast amount more than it is costing now in treating the consequences of smoking, drinking and obesity.
In the past our population was kept roughly in balance because as many people died as were born. The balance today has been completely reversed and the population is zooming as a result.
Might it not be better in the long run to allow people to choose to eat, smoke and drink themselves to death as they always did?
Roy Stockdill
says...
10:01pm Fri 13 Jan 12
Sue was like me, totally non-PC. She smoked (which I actually do not), drank wine and champagne as if it was going out of existence (which I do) and ate red meat (which I also do). She loathed health fascists who wanted to tell her what to do! She ignored them, as I do, and died at 58 of pancreatic cancer, which has little to do with lifestyle because in her case it was probably hereditary since her father died of it also.
Several hundred of we tabloid hacks had a wonderful time (along with a few famous celebs) remembering her, had a lot of laughter and a few tears, a lot to drink, and we all left the church and her wake feeling better. She was described in an address by the Daily Mirror editor as a "cross between Rita Hayworth and Elsie Tanner". Sue was a gorgeous, feisty, fighting female journalist, a Geordie from Newcastle, who emphasised all the best (and probably the worst) in my former profession. She was glamorous, exotic, extravagant and funny and much loved. Yes, she died at only 58 but she had a far, far more interesting lifestyle than boring little nobodies who live to be 90 and more but spent all their lives working in a town hall or bank or building society. She loved every minute of it, as I have done of mine.
Which would you rather be? I know what the health fascists would say but I also know which I would rather be! If I fell under a bus tomorrow I would say that I've had a great life, travelling the world, meeting lots of famous people and getting drunk in bars from Manchester and Madrid to Manhattan and San Francisco! How many can say that? But if they have their way, the health fascists and nanny state busybodies don't want you to do that
because it upsets them too much and causes them too much work.
Sod them, I say!
Hornets number 12 fan
says...
10:15am Mon 16 Jan 12
Toshhorn wrote:Exactly! Fatness is not always the fault of the patient. Prescription drugs can cause weight gain and as you said having mobility problems due to arthritis can cause it too. People ALWAYS assume fat people are crisp munching,fast food hoovers!
I was always slim and sporty until arthritis and stiff joints kicked in,
I stopped smoking (ten years ago), put on the weight (I'm now just under 17st , 5ft11 ins tall and the Doctor said I was obese)and now can't excercise because of the above,
Constant knee, back and neck pain is driving me mad, but I still go to work everyday.
It's not nice struggling in this way and now there is no point me visiting a doctor for anything, because I am fat.
To all those in good health out there, look after yourselves.
To all us fatties, if you can't lose the weight, tough, just go away, nice caring people, I give up.
You can't be racist,sexist or ageist but it's ok to hate the fat people.
This is just not the case. People just blindly listen to Government spin and they take it all in then join the witch hunt of the group pf people concerned!
Hornets number 12 fan
says...
10:20am Mon 16 Jan 12
Roy Stockdill wrote:Hear hear Roy! Bloody Nanny state gets right up my hooter
I would like to add that on Wednesday of this week I attended the funeral and wake at Fulham of one of my oldest friends and colleagues, Sue Carroll, with whom I worked for a number of years on the News of the World. Sue became a columnist on the Sun and then the Daily Mirror, where she wrote a controversial weekly column for 13 years. Reports of her obituary and funeral are easily found online and many tributes have been paid to her.
Sue was like me, totally non-PC. She smoked (which I actually do not), drank wine and champagne as if it was going out of existence (which I do) and ate red meat (which I also do). She loathed health fascists who wanted to tell her what to do! She ignored them, as I do, and died at 58 of pancreatic cancer, which has little to do with lifestyle because in her case it was probably hereditary since her father died of it also.
Several hundred of we tabloid hacks had a wonderful time (along with a few famous celebs) remembering her, had a lot of laughter and a few tears, a lot to drink, and we all left the church and her wake feeling better. She was described in an address by the Daily Mirror editor as a "cross between Rita Hayworth and Elsie Tanner". Sue was a gorgeous, feisty, fighting female journalist, a Geordie from Newcastle, who emphasised all the best (and probably the worst) in my former profession. She was glamorous, exotic, extravagant and funny and much loved. Yes, she died at only 58 but she had a far, far more interesting lifestyle than boring little nobodies who live to be 90 and more but spent all their lives working in a town hall or bank or building society. She loved every minute of it, as I have done of mine.
Which would you rather be? I know what the health fascists would say but I also know which I would rather be! If I fell under a bus tomorrow I would say that I've had a great life, travelling the world, meeting lots of famous people and getting drunk in bars from Manchester and Madrid to Manhattan and San Francisco! How many can say that? But if they have their way, the health fascists and nanny state busybodies don't want you to do that
because it upsets them too much and causes them too much work.
Sod them, I say!
Turvey Tortie
says...
4:12pm Mon 16 Jan 12
Altenatively return to a service for all.
Such selection is the thin edge of the wedge the list above will follow bit by bit you see.
Me? I don't live in Herts so currently not my problem! But you do have my sympathy
Turvey Tortie
says...
4:14pm Mon 16 Jan 12
Roy Stockdill
says...
4:50pm Mon 16 Jan 12
Well, anyone who starts asking me those impertinent questions that have little relation to what I am at the surgery for is going to get a very short and sharp reply because this is the bullying nanny state in full cry!
I have already exercised my right to opt out of the national database of ALL medical records that the NHS is attempting to build up because it seemed to me the thin end of the wedge. Make no mistake, whatever shade of government is in power, whether Left, Right or Coalition, the powers-that-be are determined to try and gather as much information as they possibly can on all private citizens. We should fight it all the way down the line because the nanny state is also a totalitarian state.
JonBoy
says...
8:19am Tue 17 Jan 12
The Rover
says...
11:14am Tue 17 Jan 12
JonBoy wrote:Only the fat disabled!
does this policy discriminate against the disabled?
garston tony
says...
11:35am Tue 17 Jan 12
By the same token Roy there are many people in their 80's and 90's who have lived extremely interesting lives and who still have their faculties about them and are still mobile.
If people choose to ignore health advise that is of course their own choice however as with many things why should their choice mean a cost burden to the rest of us?
stuegs
says...
12:31pm Tue 17 Jan 12
Surely, its common sense that those who ignore health advice should be further down the list when it comes to non urgent treatment.
Roy Stockdill
says...
4:10pm Tue 17 Jan 12
For just one example, we keep reading that the maximum number of alcohol units that should be consumed in a week is 21 for men and 14 for women. Who says so? Some committee somewhere? Why exactly 21, why not 20 or 22, 23 or 24? Does someone simply pluck these figures out of thin air? I was told this fact some time ago by a very bossy diabetic nurse and I asked her to explain where the figures came from. She couldn't, simply muttering something about them being "the laid-down guidelines". But who laid them down, I asked? She couldn't answer me. I pointed out to her that this one-fits-all rule is nonsense because it fails to take into account one vital factor, i.e. everybody has a different tolerance level to alcohol.
So-called health professionals, it seems to me, fail to take into account that every patient is different and has different needs and tolerance levels. However, this is too much bother for them - much simpler to lay down inflexible rules and treat everybody exactly the same.
JonBoy
says...
2:32pm Wed 18 Jan 12
The Rover wrote:you try exercising when you're disabled you fool
JonBoy wrote: does this policy discriminate against the disabled?Only the fat disabled!
JonBoy
says...
2:35pm Wed 18 Jan 12
Roy Stockdill
says...
3:03pm Wed 18 Jan 12
Sometimes - though I wouldn't say "far more" - but nothing like as much as I used to when I was on expenses and spending Rupert Murdoch's money!
Who was it who said "A day without wine is like a day without sunshine"? Well, I agree! Wine is one of the few civilised pleasures of life remaining when you reach a certain age and no interfering busybody is going to stop me from having a glass or three of a decent red with my dinner.
garston tony
says...
9:31am Thu 19 Jan 12
Roy you are right, the guidelines don’t take into account individuals circumstances but on the whole they are an accurate median point on which to base health advice.
'm surprised at you calling something which is based on scientific research wrong, I thought with you science was the all mighty truth which we must all bow down to? Are you saying that science doesn’t get everything right and doesn’t know everything? Glad you're finally getting the point.
Roy Stockdill
says...
9:55am Thu 19 Jan 12
Anyone who wants me to give up this simple pastime will have to fight me first! On the whole, I find non-drinkers exceedingly boring, rather smug and prone to issuing patronising advice to others when they should be minding their own business.
Looking back on my life, I would hardly change a thing. As a journalist for the best part of half a century, as I said earlier I've travelled widely in Europe and America, wined and dined with famous people, publishers, MPs, business folks and so on and had probably several million words published in newspapers, magazines and books. Most people have never had anything published in their whole lives! Now at the start of my eighth decade, I am still beavering away as a freelance writer and genealogist, still being published widely in magazines.
And, yes, like the vast majority of journalists, I've consumed a lot of alcohol over the years! It goes with the territory - we are like showbiz people, we work hard, play hard and lead an unconventional and peripatetic life.
However, if somebody had told me 50 years ago when I first started out on this career, that I could extend my life by 5 or maybe even 10 years by taking a boring job in a bank, building society, town hall or shop, going home at 5.0 o'clock every night and never touching alcohol, I would still have taken the option I did. What is life for if not for living?
stuegs
says...
12:23pm Thu 19 Jan 12
You really are a plonka!!
Roy Stockdill
says...
12:40pm Thu 19 Jan 12
For one thing, I enjoy a good debate, especially with obviously rather stupid people such as yourself who seem to take life so seriously. I enjoy a good wind-up!
Secondly, what you call shameless self promotion I call good advertising. You will probably not understand this, but any professional writer will tell you the same: even after 55 years (I started as a 16-year-old on my local evening paper in Yorkshire) I still get a buzz out of seeing my name in print, and I mean my real name not some silly little pseudonym. I also get a further buzz when the cheque arrives!
I recently had a page lead in the Daily Mail, answering a question about genealogy, which was obviously well noticed because it has brought me several clients who want to hire me for my professional services.
If you care to find me in any of the Rootsweb genealogy mailing lists you will find that I usually append to my signature the old Oscar Wilde aphorism that goes: "There is only thing worse than being talked about, and that is not being talked about."
No such thing as bad publicity, you see, which is why I still enjoy blowing my own trumpet, especially when it gets up the nose of people like you! Those who know me well have come to expect it of me.
stuegs
says...
1:37pm Thu 19 Jan 12
You have made quite an assumption by suggesting i am stupid, but i guess that just reinforces the stereotype that surround most journalists these days, its a shame really.
And by the way, if we 're playing 'top trumps celebrities iv met' im pretty sure id beat you hands down. Im a fireman and when off duty i provide fire cover for film crews and special effects. Just finished the latest Johnny Depp film, about to start the new James Bond. Ill say hi to Johnny and Daniel from you.
Roy Stockdill
says...
1:51pm Thu 19 Jan 12
Didn't they teach you at school about the use of the apostrophe and that the personal pronoun of the first-person singular (I) is always written in upper case?
stuegs
says...
1:57pm Thu 19 Jan 12
Well, i bet you d be useless at putting out fires and cutting people out of cars. I guess its all relative
garston tony
says...
2:20pm Thu 19 Jan 12
Oh, and you may not like non drinkers, many people don’t like self promoters especially if they are so obviously full of wind.
Roy Stockdill
says...
2:48pm Thu 19 Jan 12
Virtually all the great actors that I can think of were big drinkers and died early, i.e. Richard Burton, Richard Harris, Trevor Howard, Wilfrid Lawson. So were many of the great writers and painters, Alcohol fuelled their genius - think of Ernest Hemingway, Dylan Thomas, Van Gogh, Francis Bacon et al. Not to mention brilliant sporting personalities like George Best, Brian Clough and Alex "Hurricane" Higgins.
But who do you think left far greater legacies - they or some obscure little nobody who spent his entire life working behind a desk in a bank or building society or even worse, a town hall, and never made a single blip in the history books?
Bauer_Is_Back
says...
12:52am Fri 20 Jan 12
As for Roy, the Guardian would call you a cult. Get of your high horse!
Roy Stockdill
says...
6:17am Fri 20 Jan 12
As for the Guardian, I care about as much what that ailing, failing newspaper - read principally by teachers, social workers and an assorted ragbag of loony lefties - thinks as I do about the opinions of Victoria Beckham or Colleen Rooney!
garston tony
says...
9:22am Fri 20 Jan 12
Roy Stockdill
says...
9:41am Fri 20 Jan 12
After taking early retirement, I then embarked on a second career as a genealogist, turning a hobby of 40 years into another occupation.
I am still working all day today at home on the computer but in a different field, researching and writing articles for magazines and also for a few select professional clients. I am one of those people who love their work so much - whereas most people seem to hate their jobs and can't wait to give them up - that I would almost certainly drop off the perch if I had to give up! I cannot envisage myself ever retiring.
Quick final thought: I also love winding up boring, smug, po-faced politically correct nonentities with no vestige of a sense of humour!
cameluk says...
5:51pm Mon 9 Jan 12