"NHS may not treat smokers, drinkers or obese"
Discussion
The National Institute for Health and Clinical Excellence (Nice) which advises on the clinical and cost effectiveness of treatments for the NHS, said that in some cases the "self-inflicted" nature of an illness should be taken into account
Telegraph article
NHS may not treat smokers, drinkers or obese
By Celia Hall, Medical Editor
(Filed: 09/12/2005)
People who are grossly overweight, who smoke heavily or drink excessively could be denied surgery or drugs following a decision by a Government agency yesterday.
The National Institute for Health and Clinical Excellence (Nice) which advises on the clinical and cost effectiveness of treatments for the NHS, said that in some cases the "self-inflicted" nature of an illness should be taken into account.
But the report bars any discrimination against patients on grounds of age alone.
Nice stressed that people should not be discriminated against by doctors simply because they smoked or were overweight. Its ruling should apply only if the treatment was likely to be less effective, or not work because of an unhealthy habit.
The agency also insisted that its decision was not an edict for the whole NHS but guidance for its own appraisal committees when reaching judgments on new drugs or procedures.
But the effect is likely to be the same.
Nice is a powerful body and the cause of much controversy. It is seen by some as a new way of rationing NHS treatment.
Across the country primary care trusts regularly wait for many months for a Nice decision before agreeing to fund a new treatment.
One group of primary care trusts is ahead of Nice. Last month three PCTs in east Suffolk decided that obese people would not be entitled to have hip or knee replacements unless they lost weight.
The group said the risks of operating on them were greater, the surgery may be less successful and the joints would wear out sooner.
It was acknowledged that the decision would also save money.
Yesterday's report, Social Value Judgment - Principles for the development of Nice guidance, said no priority should be given to patients based on income, social class or social roles at different ages when considering the cost effectiveness of a treatment.
Patients should not be discriminated against on the grounds of age either, unless age has a direct relevance to the condition.
Nice has already ruled that IVF should be available on the NHS to women aged 23 to 39 as the treatment has less chance of success in older women. It also recommends that flu drugs should be available to over-65s, as older people are more vulnerable.
But the report said that if self-inflicted factors meant that drugs or treatment would be less clinically and cost-effective, this may need to be considered when producing advice for the NHS.
The report said: "If the self-inflicted cause of the condition will influence the likely outcome of a particular treatment, then it may be appropriate to take this into account in some circumstances."
It acknowledged that it can be difficult to decide whether an illness such as a heart attack was self-inflicted in a smoker.
"A patient's individual circumstances may only be taken into account when there will be an impact on the clinical and cost effectiveness of the treatment."
Prof Sir Michael Rawlins, the chairman of Nice, said: "On age we are very clear - our advisory groups should not make recommendations that depend on people's ages when they are considering the use of a particular treatment, unless there is clear evidence of a difference in its effectiveness for particular age groups.
"Even then, age should only be mentioned when it provides the only practical 'marker' of risk or benefit. Nice values people, equally, at all ages."
But Steve Webb, the Liberal Democrat health spokesman, said there was a danger of primary care trusts following the same course of action.
"There is no excuse for cash-strapped hospitals denying treatment to people whose lifestyle they disapprove of," he said. "Treatment decisions involving people's lifestyle should be based on clinical reasons, not grounds of cost. The NHS is there to keep people healthy, not to sit in judgment on individual lifestyles."
A spokesman for Nice said: "We want to reassure people that in producing our guidance we are not going to take into consideration whether or not a particular condition was or is self-inflicted.
"The only circumstances where that may be taken into account is where that treatment may be less effective because of lifestyle choices."
Jonathan Ellis, the policy manager at Help the Aged, said it was pleased Nice had finally shown an understanding of the importance of tackling age discrimination.
"While this is a major feat, there is still some way to go to banish the evident inherent age discrimination that exists within health care services," he said.
"The NHS now has much to learn from this step change. It will ensure a fairer deal all round for older people using the NHS."
Telegraph article
NHS may not treat smokers, drinkers or obese
By Celia Hall, Medical Editor
(Filed: 09/12/2005)
People who are grossly overweight, who smoke heavily or drink excessively could be denied surgery or drugs following a decision by a Government agency yesterday.
The National Institute for Health and Clinical Excellence (Nice) which advises on the clinical and cost effectiveness of treatments for the NHS, said that in some cases the "self-inflicted" nature of an illness should be taken into account.
But the report bars any discrimination against patients on grounds of age alone.
Nice stressed that people should not be discriminated against by doctors simply because they smoked or were overweight. Its ruling should apply only if the treatment was likely to be less effective, or not work because of an unhealthy habit.
The agency also insisted that its decision was not an edict for the whole NHS but guidance for its own appraisal committees when reaching judgments on new drugs or procedures.
But the effect is likely to be the same.
Nice is a powerful body and the cause of much controversy. It is seen by some as a new way of rationing NHS treatment.
Across the country primary care trusts regularly wait for many months for a Nice decision before agreeing to fund a new treatment.
One group of primary care trusts is ahead of Nice. Last month three PCTs in east Suffolk decided that obese people would not be entitled to have hip or knee replacements unless they lost weight.
The group said the risks of operating on them were greater, the surgery may be less successful and the joints would wear out sooner.
It was acknowledged that the decision would also save money.
Yesterday's report, Social Value Judgment - Principles for the development of Nice guidance, said no priority should be given to patients based on income, social class or social roles at different ages when considering the cost effectiveness of a treatment.
Patients should not be discriminated against on the grounds of age either, unless age has a direct relevance to the condition.
Nice has already ruled that IVF should be available on the NHS to women aged 23 to 39 as the treatment has less chance of success in older women. It also recommends that flu drugs should be available to over-65s, as older people are more vulnerable.
But the report said that if self-inflicted factors meant that drugs or treatment would be less clinically and cost-effective, this may need to be considered when producing advice for the NHS.
The report said: "If the self-inflicted cause of the condition will influence the likely outcome of a particular treatment, then it may be appropriate to take this into account in some circumstances."
It acknowledged that it can be difficult to decide whether an illness such as a heart attack was self-inflicted in a smoker.
"A patient's individual circumstances may only be taken into account when there will be an impact on the clinical and cost effectiveness of the treatment."
Prof Sir Michael Rawlins, the chairman of Nice, said: "On age we are very clear - our advisory groups should not make recommendations that depend on people's ages when they are considering the use of a particular treatment, unless there is clear evidence of a difference in its effectiveness for particular age groups.
"Even then, age should only be mentioned when it provides the only practical 'marker' of risk or benefit. Nice values people, equally, at all ages."
But Steve Webb, the Liberal Democrat health spokesman, said there was a danger of primary care trusts following the same course of action.
"There is no excuse for cash-strapped hospitals denying treatment to people whose lifestyle they disapprove of," he said. "Treatment decisions involving people's lifestyle should be based on clinical reasons, not grounds of cost. The NHS is there to keep people healthy, not to sit in judgment on individual lifestyles."
A spokesman for Nice said: "We want to reassure people that in producing our guidance we are not going to take into consideration whether or not a particular condition was or is self-inflicted.
"The only circumstances where that may be taken into account is where that treatment may be less effective because of lifestyle choices."
Jonathan Ellis, the policy manager at Help the Aged, said it was pleased Nice had finally shown an understanding of the importance of tackling age discrimination.
"While this is a major feat, there is still some way to go to banish the evident inherent age discrimination that exists within health care services," he said.
"The NHS now has much to learn from this step change. It will ensure a fairer deal all round for older people using the NHS."
right off methinks.
Strange how the emphasis in that written version differs from the verbal version given by the head of Nice on Radio 4 yesterday. (Professor thingywhatsit)
He said that just because you were obese or a heavy smoker, that didn't necessarily bring on your condition.
However, should the treatment for that condition require that you lose weight or stop smoking, they would be within their rights to withold it should you not help yourself by continuing your bad habits. (e.g if on oxygen because of bad lungs, don't continue to smoke; at the very least it could cause an explosion!)
Sounds pretty fair to me.
He said that just because you were obese or a heavy smoker, that didn't necessarily bring on your condition.
However, should the treatment for that condition require that you lose weight or stop smoking, they would be within their rights to withold it should you not help yourself by continuing your bad habits. (e.g if on oxygen because of bad lungs, don't continue to smoke; at the very least it could cause an explosion!)
Sounds pretty fair to me.
What they actually are trying to say is that, having got to the end of the financial year, the massed ranks of bureaucrats have realised that, after paying their salaries, there isn't enough left in the pot to treat patients with. Therefore there need to be operational cutbacks that they can justify politically, in order to preserve their salaries.
How foolish. They should maintain programs to help these people control their problems. If they go untreated, they will eventually be unable to work (and have to go on the dole) because of their health, and eventually cost the gov't more. Prevention and cure are much cheaper than taking care of someone who is permanently incapacitated for the rest of their lives. What did they have to say about users of illegal drugs? Will they be treating the junkies? Smoking, drinking and food are all legal vices.
Mon Ami Mate said:
What they actually are trying to say is that, having got to the end of the financial year, the massed ranks of bureaucrats have realised that, after paying their salaries, there isn't enough left in the pot to treat patients with. Therefore there need to be operational cutbacks that they can justify politically, in order to preserve their salaries.
Reminds me of the way our Congress votes themselves pay raises. Disgusting. Wouldn't it be great if their voting constituents had a say in how much they get paid? Sure would change the way they do things.
angusfaldo said:
After what I've paid in tobacco duty?
I agree. smokers help to collect more taxes while at the same time limiting their likelihood of adding to the genepool by virtue of smoking-related diseases. Seems like the perfect situation to me
rather like that amusing Yes Minister sketch where Humphry is extolling the virtues and generosity of heavy smokers subsidising the NHS via tobacco duty but never collecting their state pensions into old-age
angusfaldo said:
After what I've paid in tobacco duty?
I agree. smokers help to collect more taxes while at the same time limiting their likelihood of adding to the genepool by virtue of smoking-related diseases. Seems like the perfect situation to me
Exactly, and i still pay NI nad more tax in the form of VAT on a some of the food I eat (meals out, biccies, etc) and on the booze I drink.
Thank God for BUPA, PPP etal.
trevorh said:
Strange how the emphasis in that written version differs from the verbal version given by the head of Nice on Radio 4 yesterday. (Professor thingywhatsit)
He said that just because you were obese or a heavy smoker, that didn't necessarily bring on your condition.
However, should the treatment for that condition require that you lose weight or stop smoking, they would be within their rights to withold it should you not help yourself by continuing your bad habits. (e.g if on oxygen because of bad lungs, don't continue to smoke; at the very least it could cause an explosion!)
Sounds pretty fair to me.
Yes indeed
I simply used the Telegraph's title, it is not one I would have chosen.
Mon Ami Mate said:
What they actually are trying to say is that, having got to the end of the financial year, the massed ranks of bureaucrats have realised that, after paying their salaries, there isn't enough left in the pot to treat patients with. Therefore there need to be operational cutbacks that they can justify politically, in order to preserve their salaries.
That is perhaps part of the reason
But there is always going to be rationing in a system which is free at the point of use and personally I think that some sort of rational basis should be used to prioritise treatment.
Jaglover said:
What they actually are trying to say is that, having got to the end of the financial year, the massed ranks of bureaucrats have realised that, after paying their salaries, there isn't enough left in the pot to treat patients with. Therefore there need to be operational cutbacks that they can justify politically, in order to preserve their salaries.
That is perhaps part of the reason
But there is always going to be rationing in a system which is free at the point of use and personally I think that some sort of rational basis should be used to prioritise treatment.
I wouldn't argue with your line of thought, my simple question would be is this rational?
Are pregnant women guilty of geting themselves into that condition? Do they deserve NHS treatment? I ride a large motorcycle and have spent years playing rugby. Is this better or worse than smoking? Is a cigarette smoker denied treament but a marijuana smoker accepted?
Mon Ami Mate said:
I wouldn't argue with your line of thought, my simple question would be is this rational?
It depends on how it is implemented
If say they are a heavy drinker and need a liver transplant then a condition to treat them would be for them to quit drinking.
If they are a smoker and need surgery, likewise.
I.e. the decision on whether to treat them is based on what they do from that moment onwards rather than necessarily based on past misbehaviour.
Another issue entirely is a moral judgement on who is more deserving of treatment if it is in restricted supply. Say you are faced with two, identically aged, patients who need liver transplants and you have only one liver available. One of whom brought the condition on themselves by heavy drinking. I would say give it to the one who did not cause his own condition.
Jaglover said:
Another issue entirely is a moral judgement on who is more deserving of treatment if it is in restricted supply. Say you are faced with two, identically aged, patients who need liver transplants and you have only one liver available. One of whom brought the condition on themselves by heavy drinking. I would say give it to the one who did not cause his own condition.
Im not comfortable with that idea, if we get to that stage maybe its just as fair to scrap the entire NHS and have everyone fend for themselves, i would rather be victim of my own responsibility. Why should i have a chunk of my money confiscated to pay for other peoples NHS treatment and then not have enough money to deal with my own lifestyle induced illnesses.
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