Discrimination and prejudice in the NHS?

pinno

Just so we don't annoy people in the 'Seemingly trivial things that annoy you' thread...

As a precursor to the uninitiated;

http://www.bbc.co.uk/iplayer/episode/b0 ... is-the-nhs

30 mins in:

http://www.bbc.co.uk/iplayer/episode/b0 ... t-13042017

Quoting rjsterry as he makes some good points:

rjsterry wrote:

Pinno wrote:

There was a documentary the other night about fat folk wanting more surgery and the 'prejudiced NHS'. They are full of bollox. I'm not saying that there isn't prejudice in the NHS, it's just that they are determined to blame their obesity on other factors than too many calories in and not enough going out. I bet less than a few percent actually need stomach reducing surgery because of a genuine medical complaint. We never saw the amount of overweight people in the 70's and 80's that we do now.
Personally, I have had to overcome all sorts of obstacles to get out on my bike including under active thyroid. What's their excuse?

I don't know what other people thought of the programme:

http://www.bbc.co.uk/iplayer/episode/b0 ... is-the-nhs

Good for you in overcoming those obstacles.

The NHS doesn't and shouldn't determine treatment on the basis of whether the patient has any responsibility for the illness or injury. Heading down that road is a slippery slope to doctors making dubious decisions on whether the patient 'deserves' the treatment. Where do we then stand on any mental illnesses or conditions that have a mental component? Should they all just pull themselves together?

I took the point of the programme to be that by the time dangerously obese people are eligible for gastric surgery, the possibilities for 'just eating less and doing more exercise' are long gone. They were all effectively stuck in a position where the secondary conditions related to the obesity - serious heart disease, diabetes, depression - made meaningful exercise and weight loss required by the CCG in order to qualify for treatment was impossible. I think the secondary point was that general societal attitudes to obesity - that it's really all their own fault - are affecting treatment decisions at earlier stages, which ends up pushing more people into the kind of situation shown on the programme.

I think the question of why obesity is more of a problem now is probably mostly to do with the availability of cheap very high sugar food, but if it was as simple as that we'd probably already be solving it.

This is a moral conundrum.

Let's take obese people for a start. Some of those who want gastric surgery would probably benefit from some sort of psychiatric treatment. If we are going to keep going down the road of offering surgery right, left and centre, we will break the NHS. Should there not be some sort of psychological assessment to see if it would not be better to assist then in some non-surgical manner?
Addicts get... methodone.
Obese people get... surgery?!

Both are curing the symptoms. Gone are the days of preventative medicine. We have a growing population (in more ways than one) and an ageing one. How do you finance a nation getting more and more dependent on the NHS?

Let's take the total 'treat everyone, regardless of circumstances scenario.
My mother was eventually put on a waiting list for bi-mitral valve replacement. 16 weeks. Except it turned into 23 weeks. Her heart problem was as a result of Rheumatic fever back in the day it was treated like any other common cold. She endeavoured her whole life to eat well, take care of herself and exercise. How many people on that waiting list were there because of self-inflicted problems?
The mere fact that a percentage of those people on that waiting list were there due to poor lifestyle choices and almost certainly, her op was delayed due to other 'more urgent operations' by people who had been a major contributor to their own health problems. (The scenario and my assumptions could be totally hypothetical of course).
Therefore, my mother suffered discrimination and had to wait longer by virtue of the fact that there were people who were on that list who had not taken care of themselves. What if she had died during that extra 7 weeks? Is that not indirect discrimination?
If we roll this (not improbable) scenario across all the medical faculties, then people who take care of themselves are being prejudiced against. This is the flip side.

I have an ex employee. He became a heroin addict whilst in prison. He was in prison due to his own misdemeanour's.
He has some serious health problems. Primarily, COPD and secondarily, a stomach that has ulcerated.
His treatment by the local GP is not a patch on mine. I get treated totally differently and they will bend over backwards to make sure i'm alright.
When he describes the attitude towards him, his treatment is totally mechanical. He still gets treatment but it takes far longer to do, even from the point of the getting an appointment with the GP.

It's all very well to have the holistic perspective but it's unsustainable. If people are obese or they smoke or they drink too much alcohol have the thought in the back of their heads (or even subconsciously) that the NHS is always there as a safety net regardless of their condition, then maybe it's no deterrent to poor lifestyle choices.
If people had to make a change in their lifestyle before being considered for major intervention, perhaps their attitude would be different. If a fat person thinks that the solution to their problem is gastric surgery and they think they have a god given right to it, then they are not going to make the lifestyle changes that they need to.

Garry H

There's a good argument for discriminating over who gets treatment in an economic environment where resources are being overstretched. Somebody will always lose out. Why shouldn't it be those who haven't given a thought about themselves until it's too late?

diplodicus

What about sports injuries? Should I be denied treatment because I chose a line that was perhaps beyond my abilities and broke my leg/hip etc? Can't get much more "self inflicted" than that :?

courtmed

diplodicus wrote:

What about sports injuries? Should I be denied treatment because I chose a line that was perhaps beyond my abilities and broke my leg/hip etc? Can't get much more "self inflicted" than that :?

I suffer from my migraines so bad I literally can't speak & have basically no strength in one arm. They were thought to be strokes for ages, recently they've decided they are in fact migraines and they're probably due to a few concussions I suffered in a short space of time as a 16/17 year old that were all sports related. Technically this is self inflicted - I went back to the sport etc.

It's a slippery slope when we start to decide what's preventable or not, what's self inflicted and what isn't. That's before you even get in to the issues surrounding drug abuse. Everyone knows the best preventative measure there is to legalise them all, but that's probably for another thread

Garry H

diplodicus wrote:

What about sports injuries? Should I be denied treatment because I chose a line that was perhaps beyond my abilities and broke my leg/hip etc? Can't get much more "self inflicted" than that :?

No, because the pursuit of a sporting activity is a healthy one. What you describe is an accident. It would be like choking on a bit of bread, as opposed to becoming fat from over eating bread.

Of course, you can argue that you'll cost the NHS more in the long run because there's a positive correlation between longevity (From maintaing a healthy life) and the cost of treatment during the final period. Cheapest option would be for us all to die unexpectadly from a heart attack.

diplodicus

Some sports are healthier than others though. Would you treat all sports injuries or would you draw the line at more dangerous ones?

courtmed

Garry H wrote:

diplodicus wrote:

What about sports injuries? Should I be denied treatment because I chose a line that was perhaps beyond my abilities and broke my leg/hip etc? Can't get much more "self inflicted" than that :?

No, because the pursuit of a sporting activity is a healthy one. What you describe is an accident. It would be like choking on a bit of bread, as opposed to becoming fat from over eating bread.

Of course, you can argue that you'll cost the NHS more in the long run because there's a positive correlation between longevity (From maintaing a healthy life) and the cost of treatment during the final period. Cheapest option would be for us all to die unexpectadly from a heart attack.

Where do you draw the line? Alright cycling's good for you. Why were you cycling down the side of a mountain going 40mph+ though? You were rock climbing? That sounds dangerous.

edit - or what diplodicus said...

Garry H

Climbing is still a healthy pursuit. Falling is accidental.

diplodicus

Garry H wrote:

Climbing is still a healthy pursuit. Falling is accidental.

Falling is accidental in so far as nobody sets out to do it, but it is riskier if you climb.

I don't think anyone sets out to be obese, so perhaps that's accidental too?

Garry H

diplodicus wrote:

Garry H wrote:

Climbing is still a healthy pursuit. Falling is accidental.

Falling is accidental in so far as nobody sets out to do it, but it is riskier if you climb.

I don't think anyone sets out to be obese, so perhaps that's accidental too?

But once you start falling there's nothing you can do about it...

diplodicus

I guess so

Garry H

See, i've thought about this. I used to climb

rjsterry

Other potentially self-inflicted illnesses: skin cancer has a very direct link to chasing that tan instead if covering up. Many other cancers correlate to a variety of lifestyle factors but a direct link is impossible to prove in an individual case. Do you give these people the benefit of the doubt?

Going back to the obesity programme, the idea that anyone is handing out surgery willy-nilly is just daft. This is only offered (or not as in the cases illustrated) in extreme cases where other attempts to deal with the problem have failed. The point was also made that the bariatric surgery was cheaper than continuing to treat the obesity along with its associated heart disease, high blood pressure, diabetes and musculoskeletal problems until the obesity killed the patient.

On climbing: there's quite a spectrum of risk there. Where do you draw the line between acceptable and foolhardy?

surrey_commuter

The wider issue is rationing of scarce resources. Surely it would be more efficient to allocate resources to more worthwhile members of society. Heart surgeons before bond traders, young mothers before elderly spinsters..

We would not need heart surgeons if we decided that heart surgery was uneconomic.

bbrap

Whilst this is a brilliant topic for discussion I fear there will never be any solution to please everyone but here is my take on it. Many arguments over what constitutes "self inflicted" seem to concentrate on what can be avoided by the individual concerned. However in the case of obesity there is a crucial difference which seems to be overlooked. If you smoke too much, or drink too much you are likely to have a problem but it is by no means certain. You may get lung cancer, you may not. You may get cirrhosis of the liver, you may not. However if you eat 10,000 calories a day you will definitely become obese, no maybe, you will (I'm talking normal population not some freak of nature sports person who trains 23 hours a day). Given that it does not happen overnight and that it is widely publisised that being huge is not healthy there should be a concerted campaign to stop people getting like that. As it is clearly not working at the present maybe a more forceful approach needs to be taken. How about the complete removal of bariatric surgery from the NHS? How about stating that if you want surgery you pay for it privately. We seem to tolerate the abuse of our systems by allowing members of our society to do exactly whatever they like in the knowledge that someone will pick up the pieces. Maybe its time to stop being so accommodating and start stigmatising people in that same way that drink drivers were.

slowmart

The NHS is born on July 5 1948 out of a long-held ideal that good healthcare should be available to all, regardless of wealth.

When health secretary Aneurin Bevan opened the Park Hospital in Manchester it was the climax of a hugely ambitious plan to bring good healthcare to all. For the first time hospitals, doctors, nurses, pharmacists, opticians and dentists were brought together under one umbrella organisation that would be free for all at the point of delivery. The central principles were clear: the health service would be available to all and financed entirely from taxation, which meant would people pay into it according to their means.

What's changed? It's not viewed or used as a safety net for the poorest, the landscape of provision has changed in every conceivable metric cost, volume and pull on resource, demand, improvement and effective treatreatmemt which prolongs life and increases the burden, the drug companies rape the system through their pricing models, people see access to the best treatment as a right but want it ASAP, in the west we see death as preventable without a balance of cost/value.

I would'nt have a problem with gateways for access to healthcare. what that looks like is open to discussion but I doubt any political party will be brave enough to advocate change and let people with self inflicted conditions though lifestyle choices die. Which in essence is the reduced context.

courtmed

bbrap wrote:

Whilst this is a brilliant topic for discussion I fear there will never be any solution to please everyone but here is my take on it. Many arguments over what constitutes "self inflicted" seem to concentrate on what can be avoided by the individual concerned. However in the case of obesity there is a crucial difference which seems to be overlooked. If you smoke too much, or drink too much you are likely to have a problem but it is by no means certain. You may get lung cancer, you may not. You may get cirrhosis of the liver, you may not. However if you eat 10,000 calories a day you will definitely become obese, no maybe, you will (I'm talking normal population not some freak of nature sports person who trains 23 hours a day). Given that it does not happen overnight and that it is widely publisised that being huge is not healthy there should be a concerted campaign to stop people getting like that. As it is clearly not working at the present maybe a more forceful approach needs to be taken. How about the complete removal of bariatric surgery from the NHS? How about stating that if you want surgery you pay for it privately. We seem to tolerate the abuse of our systems by allowing members of our society to do exactly whatever they like in the knowledge that someone will pick up the pieces. Maybe its time to stop being so accommodating and start stigmatising people in that same way that drink drivers were.

But the flaw with this is that it sounds like you're talking about people drinking and smoking slightly too much, then someone eating 10,000(!) calories a day if you're talking 10,000 calories a day you should probably be comparing that to like smoking 100 a day or drinking 50 cans a day - if not more. You seem to have taken it to an extreme for eating but not the others.

mamba80

Prob is if you dont treat obesity with gastric surgery etc then their other illnesses and lack of mobility end up costing more... unless you think that fat people should forgo all treatments?

Bottom line is that other countries manage to surpass what the NHS can provide, so maybe we need to look at how we fund and structure the NHS, rather than saying we cant afford x y or z.

pinno

mamba80 wrote:

Prob is if you dont treat obesity with gastric surgery etc then their other illnesses and lack of mobility end up costing more... unless you think that fat people should forgo all treatments?

If gastric surgery is cheaper in the long run, then yes - provide it but it's still a cure rather than a preventative measure.

mamba80 wrote:

Bottom line is that other countries manage to surpass what the NHS can provide, so maybe we need to look at how we fund and structure the NHS, rather than saying we cant afford x y or z.

Bottom line is that we have an ageing and sick population. I'd love to get my hands on stats from the Scandinavian countries or France, Germany to make the direct comparison of spending per head of population on Healthcare.

If you go to France skiing or mountaineering, insurance is virtually obligatory or you could be handed a big bill even with reciprocal health arrangements. Why not have insurance if you want to go rock climbing or downhill on a bike at 40+ mph?
Then you can partake inn your dangerous (though possibly healthy) sport.

Re.: Pharmaceutical companies - f*cking mercenaries.

mamba80

yep agree on health insurance for dangerous hobbies.

also remember that the obese, smokers, alkies etc tend to die younger, so dont draw a pension for too long.

though our health spending is close to the EU avg (it is lower) we lag way behind on numbers of Dr;s per head of pop and hosp beds too, so are we getting vfm ????

i d like to to see some form of mutual or coop insurance involvement similar to the french model, but mention that and the hoards descend screaming the NHS is to be privatised.

Perhaps the biggest issue is that we dont know how to treat our selves and totally rely on the nhs for everything.

but without the pharma companies, we d have few drugs.

rjsterry

Slowmart wrote:

What's changed? It's not viewed or used as a safety net for the poorest,

I think you are confusing the NHS with the welfare state.

Honestly, you'd think it was still the 19th century to read some of these posts. I'm just waiting for someone to suggest sterilisation for the poor so that they are less of a burden on society. Funny how people only think that the NHS can't afford treatment that affects other people.

DeVlaeminck

Too many difficulties in determining what constitutes a dangerous activity that requires insurance. Any cyclist can do 40mph down a hill, where does scrambing up a scree slope become climbing, is sledging the same as skiing - that kind of stuff. As for fat people being treated for weight related conditions - I expect it's hard to prove conclusively most of them are related to diet in that particular case. Yes poor diet might lead to diabetes or a heart condition or whatever but I suspect in the majority of conditions some unlucky people just have bad genes rather than a particularly bad lifestyle.

If the problem is that big we need to look at preventing so many people becoming obese - there are a lot of things we could do that wouldn't overly impact on freedom of choice but that haven't been tried yet. For a start do we really need to have litres of fizzy pop, crisps, chocolate and alcohol in supermarkets. When I was a kid grocery shops didn't generally sell all that or at least to the same extent. Is it necessary for petrol stations to have racks of sweets next to the tills etc etc.

Yes it would need government to legislate and no doubt some people would bitch about their right to live an unhealthy lifestyle is being taken away but we could do a lot without actually banning anything, just not sticking it right under their noses.

slowmart

rjsterry wrote:

Slowmart wrote:

What's changed? It's not viewed or used as a safety net for the poorest,

I think you are confusing the NHS with the welfare state.

Honestly, you'd think it was still the 19th century to read some of these posts. I'm just waiting for someone to suggest sterilisation for the poor so that they are less of a burden on society. Funny how people only think that the NHS can't afford treatment that affects other people.

It seems we have a momentum member here, it's not about class war with the boot of the capitalist on the throat of the poor.

Read the first two paragraphs which explains the foundations for the NHS.

And no one is advocating the poor not accessing the NHS. The argument is the model is unsustainable and how to make the model fit for the future.

pinno

Slowmart wrote:

rjsterry wrote:

Slowmart wrote:

What's changed? It's not viewed or used as a safety net for the poorest,

I think you are confusing the NHS with the welfare state.

Honestly, you'd think it was still the 19th century to read some of these posts. I'm just waiting for someone to suggest sterilisation for the poor so that they are less of a burden on society. Funny how people only think that the NHS can't afford treatment that affects other people.

It seems we have a momentum member here, it's not about class war with the boot of the capitalist on the throat of the poor.

Read the first two paragraphs which explains the foundations for the NHS.

And no one is advocating the poor not accessing the NHS. The argument is the model is unsustainable and how to make the model fit for the future.

This ^^.

mamba80

DeVlaeminck wrote:

Too many difficulties in determining what constitutes a dangerous activity that requires insurance. Any cyclist can do 40mph down a hill, where does scrambing up a scree slope become climbing, is sledging the same as skiing - that kind of stuff. As for fat people being treated for weight related conditions - I expect it's hard to prove conclusively most of them are related to diet in that particular case. Yes poor diet might lead to diabetes or a heart condition or whatever but I suspect in the majority of conditions some unlucky people just have bad genes rather than a particularly bad lifestyle.

If the problem is that big we need to look at preventing so many people becoming obese - there are a lot of things we could do that wouldn't overly impact on freedom of choice but that haven't been tried yet. For a start do we really need to have litres of fizzy pop, crisps, chocolate and alcohol in supermarkets. When I was a kid grocery shops didn't generally sell all that or at least to the same extent. Is it necessary for petrol stations to have racks of sweets next to the tills etc etc.

Yes it would need government to legislate and no doubt some people would ***** about their right to live an unhealthy lifestyle is being taken away but we could do a lot without actually banning anything, just not sticking it right under their noses.

yeah i agree its a grey area, perhaps the ans is that we need to accept that in our modern world, we all need to pay more tax and take better care of our bodies and that includes gov legislating against things like pop and junk food too.

Mikey23

Im treated as a celeb at my local hospital because im skinny and fit. So i throw myself off my bike a lot and require extensive and expensive and time consuming surgery to replace my shattered clavicle and give me a total hip replacement because im bonkers enough to ride on icy days. I reckon ive cost the NHS more than if i was morbidly obese...

pinno

Mikey23 wrote:

Im treated as a celeb at my local hospital because im skinny and fit. So i throw myself off my bike a lot and require extensive and expensive and time consuming surgery to replace my shattered clavicle and give me a total hip replacement because im bonkers enough to ride on icy days. I reckon ive cost the NHS more than if i was morbidly obese...

Total cost to the NHS for Diabetes in 2016: £14bn.
Average cost per patient (between £1800 to £2500): £2150 per person per annum (x lifespan)
THR: £7k to £9k.

Don't flatter yourself Mikey. What you need to rack up the costs is a Bone Marrow Transplant.

kingstongraham

Pinno wrote:

Mikey23 wrote:

Im treated as a celeb at my local hospital because im skinny and fit. So i throw myself off my bike a lot and require extensive and expensive and time consuming surgery to replace my shattered clavicle and give me a total hip replacement because im bonkers enough to ride on icy days. I reckon ive cost the NHS more than if i was morbidly obese...

Total cost to the NHS for Diabetes in 2016: £14bn.
Average cost per patient (between £1800 to £2500): £2150 per person per annum (x lifespan)
THR: £7k to £9k.

Don't flatter yourself Mikey. What you need to rack up the costs is a Bone Marrow Transplant.

That 7k can't include all costs associated with A&E, physio, etc etc surely?

mrfpb

According to this summary:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1079287/

the typical 21st centuy child uses 600kCal per day less than a child of the 1950s. We are less active than our ancestors to the extent that we would need to walk 8 miles a day to catch up. Once the pattern is set in childhood it tends to continue into adulthood. Unless we can find a way to make increased energy expenditure and/or decreased consumption a way of life, then the obesity crisis will continue.

A good qoute from the end of the particle:

For every complex problem there is a simple solution— and it is always wrong.

Garry H

The obese are also probably more likely to be unemplyed.

bbrap

Garry H wrote:

The obese are also probably more likely to be unemplyed.

You'd think wasters would be skinny.