Ban on surgery for patients who are overweight or who smoke?

I don't think it's incredibly naive to think that pupils take home messages about good nutrition (usually called healthy eating) from school. According to Minibags, pupils do, from early in their primary school careers and onwards. According to her "Kids know" plenty about healthy eating because they've been told about it and had lessons about it all their school lives, they just like so-called junk food.

GPs aren't employed by health trusts, but they have to meet targets to receive funding. Apparently the Vale of York has a higher than average number of referrals for hip and knee replacements. The CCG only has a limited amount of funding (the Vale of York is in debt) and has to make decisions about how money is allocated. They are having to take responsibility and make decisions, but don't have the authority to raise money in the first place.

This is a direct link to the statement which has caused all the outrage (it takes a bit of time to download, but it's safe). I compared it with my own CCG's policy and the only real difference is that it's directly linked to the financial situation. A bit of Googling will probably find people's own CCG policy.

www.valeofyorkccg.nhs.uk/data/uploads/governing-body-papers/1-september-2016/item-7.2-commissioning-statement-for-hip-and-knee-joint-replacement-surgery.pdf

It's irrelevant whether I think sport should be part of the curriculum (I do), although I hated PE at school.

I think you are being extraordinarily naive to think pupils take away messages about good nutrition from cooking lessons in school. Teenagers are more likely to be put off by any messages given out by teachers. Try teaching drugs or sex education to secondary school pupils!

Nutrition is, in any case, taught in science and pupils are bombarded with healthy lifestyle messages until fatigue sets in. It's even taught in foreign languages and I've just finished marking hundreds of essays on the subject :-(.

Food has always been a subject chosen mainly by girls. I've covered enough GCSE Food lessons in recent years to know that's still true. How would you educate the boys?

PS. Childhood obesity is falling. How would you re-train the adults (especially the ones over 60) who are the most obese?

I think I'm glad I'm in America. There are a lot of reasons for weight issues. I personally have a big stomach. If you look at me from the back I look very thin but stomach and arms for some reason don't go away. 4 kids, old age and excessive stress don't help. I have a friend who has a daughter with Cushings. She's very large due to her condition.

daphnedill I don't know why you think teaching cooking was confined to secondary modern schools. Grammar schools taught domestic science/home economics too and many pupils studied the subject to O Level.

I think the science that supports nutrition is important and it's good for children to have some knowledge of it. Practical cookery is an extension of that, in the same way as laboratory experiments are an extension of chemistry and physics, field trips complement geography, and visits to the theatre support the study of English Literature.

Sadly we can't assume that children of any social background will receive a balanced education at home and surely that is what school is for. The teacher's job (as the headmistress of a village school that my children went to put it to me)being not to fill empty vessels, but to light lamps. Having an inspirational teacher in any subject should be something that every child experiences.

You didn't say whether you think children should have the opportunity to play games and other sports in school. Is that something else you think shouldn't be forced on them?

I agree with you, thatbags. In fact, it's my belief that doctors have been exercising their own selection process for years by telling patients that surgery is not an option unless they make some sort of effort to address smoking and weight issues.
I know that excessive eating and other addictions are difficult to manage, but there is plenty of help available for those who are willing to give it a fair shot.

Blanket bans are probably not a good idea, but telling individual patients they need to lose weight or stop smoking before an operation on non-life-threatening problem just sounds like good sense to me.

People are still avoiding answering my question, so I'll answer it myself. The OP asks:

*This idea has been mooted before. However it now is looks like it might begin to happen in a systematic way, due to the government keeping the NHS so desperately short of the money it needs if it is to maintain current levels of service.
It is more expensive and more difficult to operate on people who are overweight, and who smoke. They are likely to be in hospital longer. They are less likely to make a successful recovery and feel the benefits. Is this is sensible way to ration NHS surgical treatment?*

On the face of it, it sounds like a sensible idea to me. And if, as been mentioned by a poster or two in this thread, it happens already (docs advise, possibly even insist, that patients lose weight or stop smoking before it is worth scheduling certain surgical procedures or else the procedure is basically wasted on them), why was the question even asked?

Yes doctors are employed by health trusts but they would get very angry if the trust managers started telling them how to talk to their patients. If a decision to ration certain kinds of treatment were taken it would be agreed in executive and board meetings which would include clinical managers.
Info about public health in England and cuts to health initiatives:

www.bbc.co.uk/news/health-36805577

Good point, jess. I was using the term "health trusts" rather loosely. Are doctors employed by health trusts?

My GP is pretty blunt straightforward, which no messing approach I like but many people don't. I know someone to whom he reportedly said "You are obese". She told him (so she said) that she doesn't want to be told she is obese. She seems to think he said it to be hurtful. I think he said it to try and make her face reality and in the hope of getting her to do something about it.

Doctors recommend things to their patients, not health trusts. I do wonder how these recommendations are made. I do know one retired consultant who used to be blunt with his patients but I wonder how many do. e.g. "If you don't do something about your weight you're going to die soon." But I suspect some might say things like "We recommend giving up smoking before an operation".
I don't think health trusts are in charge of public health - I think it is in the remit of the cash-strapped (even more cash-strapped) local authorities and - if they had the budget - any health education projects or classes.

daphnedill's post just before mine puts another slant on the issue, well, more than one slant, actually. She seems to be saying health trusts already tell people to lose weight and/or stop smoking before they can get certain operations. That's presumably part of the 'treatment' for their joint problems. Sounds sensible to me.

And she mentions the issue of what I'm going to call "obesity spin". I'm going to have a think about that.

eloethan, the politics of public health care funding is a fascinating subject. How to deal with the problem of already existing lack of funding, is a separate problem. My query is about what would be the most moral way health trusts could approach already lacking sufficient funding to cover all the knee and hip replacements that are required.

As I understand it (my understanding may be wrong), if a health trust overspends, it is then fined (increasing its overspend) for doing so. I presume the North Yorkshire health trust that has mooted the problem under discussion is trying to find a solution to a problem based on its current and projected funding in the near future.

Saying that better funding of the NHS might mean health trusts don't have to make such moral choices is a perfectly good argument, but it doesn't answer the question I asked. I am interested in the moral issue of having to choose which patients get a treatment that isn't available, for whatever reason (could be lack of sufficient funding; could be patient obesity, etc), to all of the potential patients.

@Eloethan

Interesting post, because I've been wondering why this news has broken now. It would appear that most CCGs already have some form of policies in place for smokers and the obese regarding certain operations, as do private hospitals.

Smokers are advised to give up smoking before any op requiring a general anaesthetic. Advice to lose weight weight is the first treatment for all people with joint problems. A policy very similar to the one in the Vale of York has been in place since last year, at the latest (that's when the policy was reviewed)in my CCG.

This latest policy has been specifically linked with a need to save money, as a result of the CCG's debt, but maybe it's just being more transparent than others.

There's so much in the news at the moment about obesity and cynical me thinks it could be part of the spin. Despite all that, I still think it's a good idea not to cut support for people to lose weight and give up smoking, which is what's happening. People should be helped to lose weight and/or give up smoking, whether or not they need an op. Maybe it's a plan to scare people rather than spending money on supportive services. It would be interesting to know who's 'spun' this particular story.

@janeainsworth

No, I'm not suggesting all children should only study academic subjects. I'm suggesting that all children should have the opportunity to study academic subjects, not have a pre-WW2 secondary modern curriculum foisted on them. I'm also suggesting that subjects such as cooking are a waste of time for the majority of pupils, who should be spending their time on subjects they can't learn outside school.

It's no wonder that some people want the return of grammar schools and free schools, such as the West London Free School and Michaela (which don't teach practical subjects), if there's pressure to make subjects such as cooking compulsory.

The kind of life skills I would teach are about how the country works, about choices and responsibilities, analysing news items, etc.

thatbags The funding is limited because, in my opinion and that of many people working in the NHS, the government - for its own ideological reasons - chooses to limit it.

As has been said many times before, Jeremy Hunt and several other Conservative MPs made contributions to a book that called for the NHS to be replaced with private insurance. If your aim is to get rid of something, it seems sensible to destabilise it first, create dissatisfaction, and then say that the current system is inoperable and must be replaced.

I reckon everybody knows obesity and smoking are health risk factors. How could anyone not know? We got told often enough and have been told for decades.

Daphnedill I may have misinterpreted your post, but you seem to be suggesting that all children should study only academic subjects.
What do you think about sport? Should that be excluded from the curriculum too?

I agree that it's dangerous territory, but do you agree that people should at least be warned that obesity and smoking, etc. are possible risk factors? They can do something about lifestyle, whereas those with disabilities can't.

And, no, lizzy, I didn't just teach academically able youngsters. I taught in comprehensives with a full range of abilities.

I agree with your comment about dangerous territory, eloethan. The problem that then hits me between the eyes is that, given a limited funding supply (fact), how can health trusts decide between one patient and another when they both need the same treatment but there is only funding for one? It seems to me that, horrendous as such decisions must be, the only thing health trusts can really fall back on to make such decisions is to try to assess which patient will "get the most out of" the treatment.

Ideally there would be no funding shortage, no shortage of hospitals, no shortage of medical staff, etc. Realistically, there always are limitations.

In my opinion, we're moving into very dangerous territory when we accept that people who have a higher risk factor of suffering from complications following surgery should be denied that surgery.

Using the same reasoning - which is basically about cost-effectiveness - it could be said that elderly people - who I would imagine carry much higher risk factors for complications after surgery - should also take a back seat. Or people with congenital disabilities. Older people tend to put on weight for a variety of reasons and people with certain disabilities, e.g. Downs Sydrome, are also more likely to be prone to obesity.

I think this singling out of certain people and possibly denying them the treatment they need could introduce a very worrying trend that might, at some stage, affect some of the people who now applaud it.

PS, lizzy, A level students have very little time, if they do an adequate amount of independent study.

What they should be learning if they're not going to university is high level skills. There's no reason why those not going to university shouldn't learn humanities subjects anyway. Just because somebody isn't a graduate doesn't mean they have to be a philistine.