I love the NHS (a little bit more than I used to)
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Dear Dr David Haslam
As Chairman of The National Obesity Forum, it was never going to be long before you got a letter from me. Your unwavering support for obesity surgery along with your justification for such a perspective demonstrates loud and clear why personal responsibility really has bitten the dust under Labour, and I’m glad that the NHS is starting to drive home the right message on this issue.
According to reports today, local NHS organisations are rationing obesity surgery – unfairly so, in your opinion - to only the most extreme cases in order to save money. You claim that this is going against official guidelines and puts an extra strain on NHS funds as patients who remain obese develop greater complications requiring more treatment. It means access to NHS weight-loss surgery in England is ‘inconsistent, unethical and completely dependent on geographical location’, a conference at the Royal College of Surgeons was told. Guidelines by the National Institute for health and Clinical Excellence (NICE) say patients with a BMI of 40 or above should be referred straight away for surgery while those with a BMI of between 35 and 40 who have other conditions such as type 2 diabetes should also be referred. However, surgeons said in some areas Primary Care Trusts are rationing the treatment to those with a BMI of 50 or even 60. Around one million people are eligible under the NICE criteria with around a quarter of them wanting to go ahead with it, but only 4,300 operations were carried out last year in England.
A survey of bariatric surgeons found that two thirds said eligible patients were being refused surgery at their hospitals, some Primary Care Trusts were imposing their own minimum BMI while others were not paying for any obesity surgery. Professor Mike Larvin, Director of Education at the Royal College of Surgeons, said: “Nice guidelines are meant to signal the end of postcode lotteries, yet local commissioning groups are choosing not to deliver on obesity surgery. In many regions the threshold criteria are being raised to save money in the short term meaning patients are being denied life-saving and cost effective treatments and effectively encouraged to eat more in order to gain a more risky operation further down the line.” Mr Alberic Fiennes, President-elect of the British Obesity and Metabolic Surgical Society, said: “We recognise the difficulties faced in dealing with a ‘new’ disease of epidemic proportions but to limit surgery to the most severely obese is unfair and short-sighted and against basic professional ethics.” You added that “bariatric surgery is among the most clinically-effective and cost-effective specialities in any field of medicine, preventing premature death, and transforming lives, whilst saving vast amounts of money for the NHS and the economy. Even the most cynical taxpayer should support bariatric surgery, alongside clinicians, in opposing the unethical and immoral barriers to surgery imposed by NHS purse-string holders.”
Let’s deal with these comments first. Professor Larvin claimed that people are being denied “life-saving and cost effective treatments” – which is true, and I’m glad to hear it. It is only a life-saving procedure because these patients have chosen very deliberately to ignore all the scientific advice and public health messages on the planet and instead continued to stuff their faces. Obesity surgery is nowhere near as cost-effective for the NHS as a patient ceasing to stuff their face by limiting their calorie intake and doing more exercise, thereby costing us the taxpayer absolutely nothing. Mr Fiennes said it was “against basic professional ethics” to deny people obesity surgery. Tell me, how it is against your ethics to expect patients to treat their own bodies with respect and not roundly abuse them day after day? How is it against your ethics to demand that your patients accept responsibility for conditions that they bring upon themselves? Finally, your remarks that obesity surgey is “clinically effective” should be ignored for similar reasons. This surgery might help people lose weight in the short-term, but what long-term message does it send out to patients and the rest of the public: it’s ok, eat as much as you want, get as fat as you want, there is always surgery to help bring you back from the brink of death. Is encouraging people to relinquish responsibility for their health really that “clinically effective”?
The statistics say it all, quite frankly. From 2008 to 2009, weight-loss stomach surgery for obesity rose 40% in one year. Hospital admissions for obesity also increased by 30% over the same 12 months, which represents a seven-fold increase since 1996/97. 48% of Primary Care Trusts are now treating more patients for obesity than three years ago. Around one in six (16%) PCTs have also increased their obesity budget seven-fold in the last three years to cope with the influx of patients. Are you happy about this? Does this sound “cost-effective” to you? There is nothing more clinically effective for treating obesity than improving a patient’s diet, getting them doing more exercise and taking responsibility for themselves – yet all you can think about is trying to make cutting people open the most popular solution to the growing obesity crisis. Instead, I would argue that it is “unethical and immoral” to promote obesity surgery and demand that people have access to it, when a massive proportion of these people have created the problem for themselves and somehow think it is acceptable to demand that the NHS i.e. the taxpayer digs them out of this hole. I’m no fan of the NHS at the best of times, but when I see obesity surgery being restricted to save money it gives me a small sense of hope that the people running the welfare state know that spending can be cut without affecting its underlying principle of helping those who need help but have fallen on hard times, rather than helping people who have created their own hard times and refuse to do anything about it.
Yours sincerely,
A.Tory
Witanagemot Blogs
Those bods at the National Institute for Health and Clinical Excellence, what are they squeaking about this time?
I haven’t seen a picture of Dr David Haslam, but it would seem all the fat in his body resides between his ears…
Haslam says that patients (sic) who remain obese develop greater complications which place further strain on the NHS.
I wonder if this is not a fallacious argument as the logical next step is that a lifestyle choice leading to morbid obesity means that, like heavy smokers and drinkers, the individual will die sooner than might otherwise be the case, thus saving the NHS money in the long run.
Hence; equilibrium.
Would that life were so easy that a simple cut, suck and tuck were enough to cure obesity forever. I don’t have any statistics, but would hazard a guess that people offered obesity surgery would be more likely to become obese once again afterwards.
It’s quite probably that the real issue here is that until the NHS started offering obesity surgery, only the rich could get cosmetic surgery. It’s one of those ‘positive liberties’ that you hear about – the freedom to live whatever lifestyle you like, and suffer few consequence (save the unpleasant experience of surgery). In a capitalist society, such liberties are the preserve of the bourgeoisie. A truly progressive society would socialise these advances and make these positive liberties available to all. When the upper middle classes can live whatever lifestyle they like and rely on ‘better living through chemistry’ to repair the damage, those who cannot afford to do so are being left behind by society.
Of course, all of that is a complete load of balls, since without capitalism there would have been no incentive for the development of obesity surgery in the first place.
P.S. Was the misspelling of ‘NICE’ in the original letter deliberate? If so, bravo – if not, I rather like it!
You missed a powerful argument against obesity surgery, LFAT.
If it were given freely to all, who would we laugh at in the street?
A very, very few obese people actually have an illness making them that way, and they deserve every bit of help that the NHS can provide. As for the rest, it is an addiction, just like smoking. As hospitals are refusing to treat smokers for some illnesses until they stop smoking, I can see no reason why they should not refuse to treat obese people for obesity related illnesses until they get their weight down. I can see no ethical difference between the two sets of circumstances.
And in case anyone tries to argue that obesity is an illness, perhaps they can explain why this “pandemic” has only occurred within the last few years and was not around during my younger days, say the 1940’s? I’m sure they won’t admit that the reason was quite simple – food rationing!
Narrower doors for supermarkets. You have to me > THIS THIN < to enter. Blame it, as air crew do, on Elf'n'Safety since fatties could obstruct emergency exits in the event of, oooh, a terrorist attack. Or something.
New Labour supporters?
@Shaun Pilkington – Particularly apt, as there’s a fuss about Air France charging them twice this morning!
Gah! Ghastly little homunculus Tam Fry now giving soundbites on this. And it’s top story on Radio 2 news.
Why? Aren’t there more important things in the world?
If you’re a news medium, actively trying to deflect the nation’s attention from the dreadful state in which the government has driven us, probably not.
I have a friend who underwent this surgery.
Within a week of leaving hospital she was participating in chat room discussions about the best way to melt Mars Bars to get the full volume past the gastric band.
Obesity is an entirely self inflicted condition, with a well known and immediatley accessible cure – eat less and do some exercise.
Surgery is a pointless waste of cash.
There may be a good economic argument in the long term. The cost of the treatment has to be balanced against the cost of care if the patient continues to eat as he currently does.
It might make more sense, despite the moral argument against spending money to treat a condition which has been totally self imposed, to treat as many as possible now and reap savings in the longer term which could then be spent more wisely.
Of course this should go with a longer term drive to teach decent ‘home ec’ in schools (like we had when I was a kid) so that we break the cycle of poor eating habits in the young.
Hang about, fatties are people and taxpayers too, you know (albeit it is their own fault for eating so bloody much).
But if you exclude fatties from NHS treatment, then by the same logic you have to exclude smokers, drinkers, careless drivers and pedestrians, women who deliberately or accidentally get pregnant and bave babies, people who take unusual risks like potholing or hang-gliding or DIY, people who have got AIDS. And on a value for money basis there’s no point treating older people who are going to die soon anyway, and why treat genetic diseases like diabetes or whatever because they’ll only pass it on to their children, thus compounding the problem.
If you think it through to the bitter end, actually nobody would qualify for NHS treatment so all the admin staff and doctors and nurses could sit round all day relaxing.
The problem with the argument of putting fixing fatties and people who hanglide into the same group is that Hangliding might involve the odd risk but shoving cream cakes in your face is dangerous every single time you do it as the risk accumulates – this is not the same as hangliding – which is possibly safer than driving!
And putting pregnancy in that list is just crazy! To be honest procreation is the only reason we are here!
There is a distinction between taking a responsibility for oneself and not engaging in well defined dangerous practices such as eating saturated fat and inhaling 20 sticks of burning leaves. There is a lot of evidence to suggest that each time this occurs accumulated damage will occur.
A further thought is that why are gastric bands restricted to fatties. I may be a size 10 but I would love a gastric band as then I could save £1000 per year on gym fees! I could say that it is unfair that I am denied this service.
‘But if you exclude fatties from NHS treatment…’
Only this one. I don’t think anyone’s suggesting that we don’t mend their broken legs.
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There should be an evaluation form for such surgery:
**Start Of Questionnaire**
Question 1. Who ate all the pies?
**End Of Questionnaire**
Part of me wonders if this problem may decrease over the next decade due to the inevitable and huge rise in cost of living (in taxes, interest rates, cost of utilities, food etc) meaning that people can’t afford to chuck as much down their throat.
Chairman of The National Obesity Forum said … “patients who remain obese develop greater complications requiring more treatment.”
But according to this http://www.theregister.co.uk/2009/06/24/overweight_live_longer/ fat people live longer
You see, they aren’t the only ones who can pick and choose which statistics to quote.
It would seem that he wants people to have surgery to make them look thinner – which may reduce their lifespan? Not a very ethical policy, is it?
No chance, FLS, as fat parasites will just attach themselves to the rest of the Welfare State, just as they have the NHS. Remember, fat now equals disabled so you KNOW they’ll turn up on the IB successor!
What they won’t do is exercise, run to keep an appointment or be tardy when the Greggs van stocks up the local bakers.
Depends how you look at it, Mrs!
From a ’selfish gene’ perspective it is a viable and attractive (no pun intended) for the obese to have surgery, even if it means they die earlier, so long as it gets them a partner and allows them to breed (and remember obesity impacts fertility so there’s maths all round on the elective surgery front!) but possibly marry and therefore be healthier and cost us less. Unless, of course, their marriage doesn’t last. And clearly, it’s worth remembering that self-control can’t be one of their strong suits…
How does one reconcile the NHS needing to save money against the freedom to smoke, drink and eat as much as you want?
John, smoking, drinking and, to an extent, with respect to snack foods, eating all put tonnes of money into the Tax system.
Equally, when you consider that the NHS will diagnose diseases for you but then not treat them, they also cheat you of the possibility of getting private insurance since no insurer will cover a pre-existing condition. I have MS so am well versed in THAT catch 22!
A depressing article. Pity the writer felt unable to add his / her name to it. Well whoever you are, try not to be so judgemental. We all – one way or another – share the same glass house, and it’s advisable to refrain from chucking rocks at each other. Mark Wadsworth (above) was spot on. Where do you stop?
All of us for better or worse possess our own emotional fault lines which can,at times, lead to behaviour that damages ourselves and our loved ones. I’m seventy two years of age and down the years I’ve seen better men and women than I’ll ever be hit the bottle and die as a result. Drugs too. Many years ago I spent time as a Samaritan Befriender. The one thing that struck me about the good people who gave their time to that organisation, was their love and compassion for those at the end of their rope no matter what the cause.
Let’s try and go a little easier on each other. Remember you could be next.
You’ve and a few others have missed the point completely – without an operation these patients will consume vast amounts of NHS resources for the rest of their lives. NICE have done the maths and it is a no brainer.
Perhaps a personal story will add a little human interest to the letter. I had always been big and yes in part that was my own fault, I was never the sporty type suffering from chronic asthma and being more a geek at school, however as I got older I tried everything to lose weight, diets, the gym. This all failed so I was put on prescription weight loss tablets with no luck so I tried some less conventional methods non prescription drugs phentermine, speed, Cocaine etc which if you believe the hype should help. All that happened was my weight went up and up.
About 5 years ago my Dr asked the local PCT to fund bariatric surgery so I went to see the consultant and we discussed the options and it was decided that I would be more suited to Roux en Y than a gastric band so 6 months later I had my surgery it was over the Aug bank holiday by christmas I had lost just over 10 stone nearly half my weight and felt the healthiest I had ever felt, my asthma has all but disappeared my excema has cleared up and I cycle to work.
However there are down sides I developed an atypical eating disorder and since then have not been able to keep most food down, after seeing an eating disorder specialist I understand that this is not uncommon in patients who undertook surgery around about the time I did due to a lack of counselling both before and after the surgery so that patients understand that that there is a lot of work that needs to be done on top of just the surgery. Vulpus mentions a friend who was in chat rooms talking about how to melt mars bars unfortunately with gastric bands this can be quite common and a lot of this is due to a lack of dieticians trained to deal with people who have undertaken bariatric surgery in the areas where people live as there are very few good surgeons in the UK I travelled from the far side of Dorset to the opposite side of Hampshire to have my surgery.
Do I regret the surgery not really although I would have liked the counselling so that I didn’t develop the eating disorder. Do I believe it should be on the NHS, yes however it should be a very last resort, counselling should be mandatory with a dietician taking an active part in the persons life for a period of time. The long term saving to the NHS I believe is a plus and I am not one who feels that people should have treatment witheld under the system we currently have.
My personal preference is for a private healthcare system with the NHS as a service for the lowest earners in society.