UK Government consider plans to deny NHS treatment to smokers and obese

[David S]

http://www.dailymail.co.uk/pages/live/articles/health/healthmain.html?in_article_id=424870&in_page_id=1774

Government consider plans to deny NHS treatment to smokers and obese
By KIRSTY WALKER
 
Last updated at 22:00pm on 26th December 2006

The controversial idea to crack down on illnesses which are deemed to be self-inflicted is one of a number of plans to reform Britain's arcane public services.

In the New Year, the Prime Minister will set up a 'People's Panel' of 100 members of the public who will be asked to consider some of the 'tough choices' facing the Government.

They will also be consulted on whether individuals should use supermarket loyalty card technology to harvest data on individuals' contact with the public services - such as hospitals and schools.

The controversial idea is aimed at monitoring people's use of public services so that they can be better tailored to what voters want and need.

But the plan will be bitterly opposed by civil liberty campaigners, who warn that Britain is turning into a Big Brother-style surveillance state.

The 'People's Panels' will be asked to consider whether patients should be offered a hip replacement on the NHS if they promise to stay slim.

Another idea includes making parents sign individual contracts with schools setting out what they must do at home to help their child's education.

A Cabinet review group on public services was shocked by the scale of the burden on the NHS caused by unhealthy lifestyles.

One source said: "Ministers were shocked by the fact that half of all years of healthy life are lost as a result of behavioural factors (eg smoking and diet)."

The idea of introducing contracts between state and citizen is one of a number of proposals being looked at by the Downing Street policy review, which was set up by the Prime Minister a month ago.

Some health authorities have already banned some patients from having hip and knee replacements on the grounds that they are overweight.

Last year, patients with a body mass index of 30 or above - the level considered obese - were told they will not be allowed surgery to replace worn out joints by some authorities.

But Mr Blair is frustrated by the pace of change in public services and wants to introduce radical reform during his final days in office.

The Prime Minister will ask the deliberative forums to consider how the government should be influencing peoples' lifestyle choices and how to make them healthier.

Mr Blair's critics will consider this latest initiative to be another time-wasting exercise before he stands down from office.

A Downing Street source said: "This engagement process will identify in more detail the areas which the public want us to focus on and develop a series of radical and progressive solutions."

The consultation will begin with 100 members of the public recruited early in 2007 to take part in the panels.

In February, regional meetings will be held where members will read versions of Whitehall briefing papers presented to ministers.

All 100 panel members will take part in a "summit" a month later, which will also be attended by junior ministers and civil servants.

Experts warned this month that obesity, which already costs the NHS £7billion a year, could bankrupt the health service if the proportion of adults who are obese rises from one in five to one in three by 2010.

Smoking related disease cost an estimated £1.7billion a year, with the same amount spent on alcohol-related problems.

Patients are already being told to kick bad habits. Hospital managers in Norfolk and Newcastle-under-Lyme, Staffordshire say that smokers are under greater risk and the policy will save them money.

But smoking campaigners Forest argue that smokers are being discriminated against and already plough £7billion into the Treasury in tobacco revenues.

[KEmperor]

Hmm, nationalize health care then deny care to fat people.  I love the socialist nanny state at work.  I assume the obese and smokers are still going to be required to pay into the system regardless, right?

[I spent the winter writing songs about getting better]

I agree with this for smokers but not obese.

[The Man From G.O.P.]

guffaw

[Filuwaúrdjan]

Something like this generally gets suggested by a certain sort of health professional every few months or so. I don't like it, and I don't like it when it's even treated semi-seriously.

[David S]

This is another illustration of how socialist health-care systems can lead to a loss of freedom and more government control of our lives. But beyond that I question whether such draconian plans would even produce the anticipated cost savings. As an illustration; two friends of mine who were heavy smokers both died of cancer in their early 60s. Both spent a few months in chemo and radiation and hospitalization and then died. I don't think either of them collected social security before they died. On the other hand I've known non-smokers who lived much longer but required much more health-care. As they aged they required more doctor  visits, more surgeries and in some cases nursing home care for many years before they died. They also collected social security for many years, putting more strain on that system as well. So the claims that these measures would reduce costs may be unfounded.

[bullmoose88]

The imperfections of any system. Obviously I'm, at this time, against socialized medicine, so take my comments for what they're worth.

I guess there are pros and cons to taking high risk people off the NHS (deny them treatment etc)...the pros are it keeps costs down to the rest of the country (everyone else paying taxes) through denial of service to those who continually abuse their bodies and later are likely to put a high strain on the system due to their continued, and willful disregard for their health.

That said and pure cost concerns aside, if your goal is to create a system that attempts to improve the entire country's health, then these are the people you have to work on the most. To deny them healthcare under this system just seems...wrong.

The way I may try and reconcile my two concerns, take it from an olde-fashioned liberal (european style), is to offer treatment for the particular ailment (diet/smoker/ailment x support groups if they don't exist already, drugs to help those who need help [Perhaps these are offered already, but the idea is to get these people whatever help they need]) but with the condition that if the person chooses to continue their risky behavior, they do so on their own and should not expect society to take on the extra burden of caring for them if they decide to shun this help given to them now (before things get awful).

Or you could try a fat/smoker/whatever tax to shift some of the cost burden onto those who strain the system. It may also serve to provide incentive to change some behavior.


Shrug. Every system has a flaw.

[Peter]

The government seems to have gotten itself into something of a rut with the health service in recent years, and not just in terms of actually getting the thing to churn out the "non-emergency/critical" stuff at good value, but also at setting a working agenda on the preventitive health care issues.

Its main thrust seems to have been on eliminating "health inequalities" between the classes. Problem is that this is very difficult. Whilst the generalisations I am about to make are by no means true across the broad, they do apply to the majority of the respective social class.

Working class adults tend to be more likely to smoke and to have an unhealthy diet. Middle class adults tend not to smoke and to have a healthier diet (though I wouldn't necessarily call the diet healthy, just not as bad). The causes of this are several, not least the fact that it is cheaper and more convenient to eat unhealthely.

With that as the general baseline of the population, it becomes very difficult to eliminate the health inequalities because those in the working classes are not looking after their bodies as much as their middle class counterparts do.

For the record, this is due to change in the coming decades. The present generation of middle class teenagers and students, drink as much (if not more) as their working class counterparts (and by this I mean binge drinking), and by leaps and bounds take more drugs. However, they don't smoke, whilst working class kids tend to. Quite what this means for the long term health of the respective classes, I'm not sure.

Back to point - this is what ultimately is prompting this policy - in order to eliminate health inequalities the government is attempting to force an on the whole more unhealthy class to be more healthy in order to meet its objective. Problem is that it will probably cut off several of the working class from the health service, thus further damaging their long term health.

[David S]

Something like this generally gets suggested by a certain sort of health professional every few months or so. I don't like it, and I don't like it when it's even treated semi-seriously.

Hopefully its just one of those things that blows over, I mean, do people eventually realize that could actually mean leaving sick people to die - It would effectively be  some form of involuntary euthanasia..

I don't remember, does the UK system allow people to purchase medical treatment or health insurance privately?

[Filuwaúrdjan]

Hopefully its just one of those things that blows over,

Agree; the lack of any thundering press releases from No. 10 hailing such an idea as An Eye-Catching Initative TM is a good sign as far as that goes.

Hopefully the idea gets buried for a while.

I don't remember, does the UK system allow people to purchase medical treatment or health insurance privately?

Yes; private healthcare was kept legal in 1948 for two reasons... the first was, basically, as a bribe to get the doctors onside to the idea of the NHS (doctors are allowed to work in both the NHS and private practice; it works as a little bit on the side for a lot of them), the second was the idea that some healthcare costs could be shifted onto the private sector (vanity operations and the like).

O/c most people can't afford private health insurance (not that it's actually any better than using the NHS to be honest; there's still a market for it because to have private health insurance is a sign of social status).

[MasterJedi]

I agree with this for smokers but not obese.

^^^^^^ Still should get rid of National Health Care anyway.

[Democratic Hawk]

I think this is an absolutely disgusting idea.

Ditto

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The working class

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Fair point. I pay more tobacco tax than many pay income tax

Dave