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Give up or we won't operate, smokers told
Last updated at 13:52pm on 23.10.06
Smokers will be denied life-changing operations unless they agree to kick the habit, it was revealed today.
Cash-strapped hospitals say patients will not be given treatments such as hip and knee replacements until they try to give up. Those who fail could be denied treatment all together.
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Managers in Norfolk and Newcastle, where trusts are millions of pounds in debt, say smokers are at a greater risk of complications and the move will help save them money on further care.
But critics accused them of putting its finances before the health of its patients - and warned it could lead to surgeons being "brow-beaten" into breaking the Hippocratic Oath.
The move will hit patients of Norfolk Primary Care Trust which is £50million in the red and provides healthcare to the residents of Norwich and surrounding towns and villages. Newcastle-Under-Lyme PCT in north Staffordshire, which is £1.4million in debt, has taken a similar decision.
Last year, health bosses in east Suffolk barred obese patients from the operating theatre until they tried to lose weight.
While urgent operations are not covered by the Norfolk policy, the treatments include hip and knee replacements as well as hernia operations.
Norfolk PCT said smokers were being targeted because they are at increased risk of complications and take more time to recover from surgery meaning they have longer - and more expensive - stays in hospital.
Stopping smoking will reduce the risk of complications - and cut the cost of their care. Simple saliva tests can quickly prove if a smoker is telling the truth about quitting.
Defending the move Dr John Battersby, the trust's director of public health, said: "The situation across Norfolk is that one in four people smokes and that is the same for the proportion of people coming through for surgery.
"There is increasing evidence that smokers have three times the number of complications as non-smokers.
"What we are proposing is that if someone who smokes is being referred for surgery, we would instead want them to be referred to a smoking cessation clinic and give them three months to stop smoking."
Dr Battersby added: "What we are doing is asking people to have a stab at giving up for three months and at the end we would review the situation. Some people will have stopped and will go on and have a referral for surgery. Others will not have stopped."
In those cases, decisions will be taken along the lines of clinical need.
The PCT says if smokers have tried hard and need the surgery, they may get it. But if it is felt they have not made a strong effort to stop and are at high risk from the proposed surgery, they may not be referred to the operation at that stage.
Dr Battersby said: "I am not saying there is an absolute block on smokers getting surgery but there is evidence that if they successfully stop smoking they have a much lower risk of developing complications and there will be a better outcome for them.
"There is a cost implication in terms of those complications. If they stop, it is going to have a positive impact on the health system."
The trusts are taking advantage of guidance from the Government's medical rationing body, the National Institute for Health and Clinical Excellence, which allows them to take patients' lifestyles into account when deciding if a treatment would be effective.
Smokers, however, claim they are being discriminated against. Neil Rafferty, of the pro-smoking pressure group Forest, said: "This is blackmail, pure and simple.
"Smokers pay their taxes like everyone else. In fact, because of the very high duty on tobacco, they probably pay a lot more tax than the average person.
"They are entitled to free healthcare and health trusts do not have the right to make up conditions."
Other critics say that while there are valid medical reasons for recommending smokers quit before an operation, finances, should not play a part in the decision to operate.
Michael Summers, of the Patients Association, said: "Finance has got nothing to do with making sure people are made well and every effort should be made to do it the best one can."
He added that managers doctors could be forced into breaking the Hippocratic Oath, under which they pledge to treat the ill to the best of their ability.
"The patient is the responsibility of the doctor or surgeon, not that of the manager of the PCT," he said. "The responsibility is a moral one. "Many of those doctors and surgeons will have taken the Hippocratic Oath and therefore they shouldn't be brow-beaten by managers over whether a patients should or should not have an operation."
Liberal Democrat Health Spokesman Steve Webb said: "If it is about making surgery more effective, that is quite legitimate.
"But if it is a back door way of trying to reduce demand and save money, it is picking on smokers.
"We all do things that are bad for our health and we shouldn't discriminate against one particular group."
Simon Lockett, secretary of the British Medical Association's Norfolk committee for GPs, said: "Clearly the PCT believes it has got to act as quickly as possible because of its financial position but I think GPs would be very concerned about this idea.
"GPs refer people when they think people need to have things done. Most people who smoke wish to stop anyway and we really do not think it appropriate that they should be disadvantaged by being forced to wait for important operations."
The ban comes as the NHS struggles to cope with mounting debt.
Officially, the deficit for the last financial year is £512million, however, it is claimed the true figure is near £1.3billion.
The Government says simple measures such as reducing staff turn-over and cutting down the amount of time patients spend in hospital before operations could save the health service £2.2billion a year.
Reader views (17)
Why do I have to give up smoking when the government tells me so? I am free to choose when I give up.
I am going to be given the choice of paying my NI tax when I give up smoking as well?
All the smokers should refuse to pay NI contributions until this silly decision changes, that way we´ll have the money to pay for private care and be operated when we need so.
- Maria, UK
This has been talked about here in Canada as well. My problem with this is twofold. First off why just smokers? What about the obese, alcoholics, diabetics who eat too much sugar or depressives who listen to sad music etc? It is definitely discrimination. Secondly do not make it a pseudo crime by withholding medical care, and continue to sell the product all the while collecting the substantial taxes from said sales. Stop being hypocritical.
- Steve, Brandon Manitoba, Canada
This is excellent. I hope one day they do something like that here.
- Chris, Canada
My Father in Law is having investigations for a furred artery. He has been advised to stop smoking. His treatment, however, will go ahead whether he smokes or not as he is paying to go private.
So, you are free to do as you wish if you can pay for it.
- Charlie, Isle of Man
Think it through.
If smokers are discriminated against then anyone who does not toe the medical line can also be discrimnated against, and we will all be at the mercy of health care professionals.
Who gave them the right to rule our lives? They weren't elected by us.
The NHS must be our right, not negotiable.
- Tony Collins, United Kingdom
I don't believe that smokers should deny non smokers the option of having an operation,I also don't like having to stand next to a smoker and share their cigarette smoke through no choice of my own
- Shirley, London
It's not just England. In the US, many doctors refuse to operate on smokers because the risks for complications are greater, and they don't want to get sued. Additionally, the recovery process is much tougher for a smoker. Besides governmental intervention, don't know what the solution is...but if you were told NHS costs and thus taxes were raised significantly because of smoking and it's impact on the system, would there be protests on that factor as well?
- Sher, USA
The implicit irony here is that most of the money that the NHS trusts have mismanaged is in fact supplied by the massive taxes that the goverment applies to tobacco products.
The bit that gets me is the hypocricy of the government over this issue: "Smoking is bad! For you, and everyone else! So, we'll demonise you in the popular press (providing a great policy for winning the middle-class NIMBY vote), and restrict the freedom of choice that you (and indeed non-smokers) formerly had regarding the establishments that you may patronise while indulging in your evil filthy habit (whereas simply allowing the owners and operators of those establishments to apply their own policies as they saw fit would have been the simplest and most elegant, not to mention democratic, solution)...
...but we won't outlaw it for the good of all, because:
1) the budget deficits created would cripple the country (especially the NHS);
2) we know that it would just create a huge wave of cross-channel smuggling operations that would dwarf the current booze-cruise problems;
3) we know deep down that prohibition would fail - after all, we've not exactly worked wonders with the control of other illegal recreational substances.
So, pay through the nose and suffer the disapproval of your peers, smokers! We hate you, but we need you. The health issues of your habit are only of concern when it comes to looking good in the media - if we really cared, we'd outlaw the stuff."
Business as usual.
- Armchair Anarchist, Portsmouth UK
This really smacks of a totallitarian state, and should be slapped down as soon as possible.
Smokers have still paid their taxes, and I would suggest this could be challenged as illegal.
- Anthony Heath, Godalming, Surrey
The reference to hip and knees smacks more of naked predjudice than science, I smell a "get out clause".
- Frank, London.
Time for people to take more responsibility for their health. The fact is there are limited resources and people who abuse their bodies with smoking, excessive eating and drinking, lack of exercise and lazy attitudes towards their lifestyles should be penalised for draining the system; those who focus on their health and act responsibly should be rewarded.
- Ollie, London, UK
Everyone has a right to equal treatment and equality of treatment follows from equality of medical assessment. In the long term I advise patients who believe they have suffered prejudice to sue their relevant English Health Service Trust, The DHSS and its guidelines, the individuals who are responsible for the decisions and Dr Battersby in particular under the Human Rights Legislation.
More happy days for happy lawyers!
- David, UK
"But critics accused them of putting its finances before the health of its patients - and warned it could lead to surgeons being "brow-beaten" into breaking the Hippocratic Oath."
The public, nowadays, are unaware that doctors no longer swear the Hippocratic Oath. As such, the Oath cannot be broken, and is one of the reasons, in tandem with resources, why we have seen a proliferation of cases of patients being involuntarily euthanised, or in the case of smoking, denied necessary treatment.
- Michael, London, UK
This is most unfair. Are the prejudiced minority aware of the amount of taxes paid by smokers? A 20 a day smoker pays around £30 per week in taxes but should they need an operation for a non-smoking induced condition, they will be refused. Where is the justice in that and no, I am not a smoker but I did believe I lived in a country where there was compassion for all.
- Jessup, Derby, UK
There is sense in this: your heart and lungs have to be in good condition to undergo general anaesthesia. I have known cases of inoperable lung cancer not because the cancer has spread, but because the cardiorespiratory reserve is so low that the anaesthetic alone would kill the patient.
- Charles Siu, London UK
As a non smoker I would reccommend all smokers to stop, but as regards the threat from hospitals to not operate on smokers, I would suggest that when these operarive's cars break down we refuse to repair them. Or if they need a mechanical/electrical service at home ignore them.
- Frank, Wolverhampton, England.
High time too.
- Phil, Waltham Abbey
