NHS: Poorest Hit by Surgery Smoking Ban

Plans to deny obese patients and smokers access to non-essential surgery go against the principles of the NHS by hitting some of the most vulnerable people in society.

The cost-cutting measure proposed by East and North Hertfordshire Clinical Commissioning Group would push those who can afford it to resort to private healthcare but the poorest patients would be forced to wait despite the fact they have less control over their health than the rest of society.

Against Clinical Guidance

Under the proposal patients who are considered obese – with a Body Mass Index of more than 40 – would not be referred to surgery unless they get below the threshold in nine months or lose 15% of their weight. Those with a BMI of 30-40 would also have to lose weight in order to be treated. Smokers would have to quit for eight weeks, which will be verified by breath-testing.

The non-urgent surgery specified includes such operations as hip and knee replacements, which means delayed patients could face months of pain.

“Singling out patients in this way goes against the principles of the NHS,” said Ian Eardley, senior vice-president of the Royal College of Surgeons.

“While it is right that patients are supported to lose weight or stop smoking, this should not be a condition of them receiving surgery. This goes against clinical guidance and leaves patients waiting long periods of time in pain and discomfort. It can even lead to worse outcomes following surgery in some cases.”

Smoking and Poverty

Research by the World Health Organisation presents a conclusive and direct relationship between smoking and poverty. “Several studies from different parts of the world have shown that smoking and other forms of tobacco use are much higher among the poor,” it said.

“For example, in Poland, the contribution of smoking to the risk of premature death among males at ages 35-69 varies by education level and in 1996 the risk of death during middle age was 5% among higher educated people, while it nearly doubled among persons with only primary and secondary education levels.

In Chennai, India, a study carried out in 1997 found that smoking prevalence was strongly linked to the level of educational attainment. Among illiterate men, the smoking prevalence was 64%, whereas it was only 21% among those with more than 12 years of schooling.”

The charity Action on Smoking and Health said recent studies have shown the same trend in the UK. “People in the lowest social groups are likely to be heavier smokers. Smokers in routine and manual occupations smoke on average 20% more than those in managerial and professional occupations.”

Obesity and Poverty

While a direct link between obesity and social class is unclear there has been a huge medical emphasis on the concept of food poverty, the recognition that poorer people have worse diets which are a direct cause of obesity.

“Poor diet is a major health risk,” said the Royal College of Physicians. “It contributes to almost 50% of coronary heart disease deaths, 33% of all cancer deaths, increased falls and fractures in older people, low birth-weight and increased childhood morbidity and mortality. A poor diet is characterised by excessive intakes of saturated fat, salt or sugar, and an insufficient consumption of fruit and vegetable, and dietary fibre.”

by Stewart Vickers

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