The National Health Service is under increasing pressure.
Doctors have long wanted patients to cut down or quit smoking before operations, or to lose weight, but a letter issued by the health authorities in Devon late last month means that what was once a request is now a demand.
In the letter, John Finn, the managing director of the NHS Northern, Eastern and Western Devon Clinical Commissioning Group, warned that "urgent and necessary measures" were needed to tackle its funding crisis.
“In short, demand for services is outstripping what we can afford,” said Finn, who is facing a £30 million (€38 million) hole in his budget, before adding that patients in the CCG’s catchment must be “encouraged” to improve their own health.In future, morbidly obese patients will be “required” to lose weight prior to routine surgery, while smokers will have to have given up the habit for six weeks before they are granted similar access to NHS operating theatres.
Cardiac operations
The exemptions that will be allowed from the new rules are few, limited only to cancer patients or those facing neurological or cardiac operations — while those who are overweight and hoping for hip or knee operations will have to slim for six months before they are allowed into theatre.
Overweight patients “are a greater surgical risk” and have worse results. Patients who are morbidly obese “will not be funded”, the CCG warned, unless its decision is overturned by an appeals panel.
Blaming the reforms pushed through by the Conservatives since 2010, Labour MP and former health minister Ben Bradshaw said the CCG's diktat was "deeply worrying news" that illustrated "the completely unsustainable pressures" facing the NHS.
The department of health — now headed by Jeremy Hunt — has so far made £10.8 billion of the savings it was ordered to impose by the treasury four years ago, though a further £9.2 billion must be found by the end of next year.
Last year, however, NHS England warned that despite the actions taken so far, “bold and transformative change” was required within the organisation, or else it would become “financially unsustainable; the safety and quality of patient care will decline”.
Doctors have an ethical duty to remember the costs of providing treatment, the Academy of Medical Royal Colleges, which believes that £2 billion could be saved, warned yesterday.
“A cultural shift is required which calls upon doctors and other clinicians to ask, not if a treatment or procedure is possible, but whether it provides real value to the patient and genuinely improves the quality of their life or their prospects for recovery,” it said.
“In other words, don’t do something because it can be done, do it if it is necessary,” the academy said, pointing to a better use of medication, tests and hospital beds.
Some of the figures included in the report are revealing: some because they illustrate the galloping rise in medical expense, but a few highlight that some procedures are cheaper than might be expected. Each hospital admission in Britain cost £1,713. Each 11.7 minute-long consultation with a GP costs £45; the average prescription dispensed during such visits costs £41. Ambulance call-outs cost £235.
However, the NHS pays £187 for an MRI scan, CT scans costs £87, while blood tests usually cost no more than £10.
Meanwhile, the purchase of medical instruments in England alone costs nearly £5 billion annually.
Cognitive impairment
Patients’ negative reactions to medication account for six in every 100 hospital admissions, the academy highlighted, particularly in cases of falls, sedation and cognitive impairment.
New rules now coming into use when doctors are dealing with elderly patients — known in the jargon as the “screening tool of older persons” – have seen 52 per cent of patients having their medications either reduced or discontinued.
In Bristol, hospitals increased the efficiency of their operating theatres by applying a relatively simple six-week ‘look ahead’ to ensure gaps caused by cancellations and other changes were filled up.
Sometimes the efforts needed to make changes require equally simple, but dogged, work. In Devon, one of the largest GP practices in the county has brought in an additional doctor to visit elderly patients at home.
Only in action for six weeks, the Beacon practice believes that the scheme – which will cost £48,000 for a six-month trial – has stopped nine people from having to be admitted to hospital – each of whom would have cost an average of £1,713, remember.