NHS hits smokers

SMOKERS are to be asked to give up their habit before they are put on the waiting list for routine operations such as hip replacements and heart surgery. National Health Service managers say smokers take more time to recover from surgery, blocking beds for longer and costing more to treat. One primary care trust will launch a consultation on the new curbs this summer to coincide with the ban on smoking in public places to be enacted on July 1. Rod Moore, assistant director of public health at Leicester City West Primary Care Trust, said it should become the norm for patients to stop smoking before all routine surgery. “If people give up smoking prior to planned operations it will improve their recovery,” Moore said. “It would reduce heart and lung complications and wounds would heal faster. Our purpose is not to deny patients access to operations but to see if the outcomes can be improved.”

NHS managers want patients not to have smoked any cigarettes for a full month before surgery. But as they would be expected to take about two months to stop, operations could be delayed by up to three months. The managers do insist, however, that it is up to doctors to decide whether the surgery can still go ahead if the patient fails to give up. Some doctors argue that the policy could deter smokers from attending appointments because they believed that they would not qualify for treatment.

By December next year, all patients will need to have had surgery within 18 weeks of having been referred to hospital by their GP, according to new government targets. To avoid endangering the targets, patients would not be added to waiting lists until they had given up smoking. Moore said: “If this were to be introduced, it would happen prior to referral [to hospital]. The clock would not start ticking. It would not interfere with the 18-week target.”

Leicester is believed to be the first trust to be planning such a wide-ranging measure since 2005, when the National Institute of Health and Clinical Excellence issued guidance that it was reasonable for smokers to be denied treatment if their habit would affect the outcome and cost of medical care. For example, doctors routinely deny smokers surgery for blocked blood vessels in the legs because they say the problem will go away if they stop smoking. Doctors also argue that if the patient continues smoking the vessels will quickly become blocked again.

Now NHS managers say patients should give up smoking whether their condition is directly caused by the habit or not. Vanessa Bourne, head of special projects for the Patients Association, said: “If the NHS is trying to reduce the number of people who qualify for surgery it should be frank about this and not pretend this is medically driven. “If hospitals really wanted to improve outcomes for patients after surgery then there are other priorities such as tackling hospital infections.

“If these patients were being treated privately they would not need to give up smoking ahead of surgery, which suggests this has more to do with money than what is in the best interests of the patient.”

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Australia: More cutbacks in Melbourne public hospitals

WARDS are being closed, surgeries cancelled and hospitals left in disrepair as the health network serving some of Melbourne's poorest battlers reaches breaking point. Western Health network is slashing its services, including to children, because of costs. Surgeons in the network -- which includes Western Hospital, Sunshine Hospital and Williamstown Hospital -- were told of the deepening crisis this week. It is understood there will be budget cuts estimated at $15 million. The consequences are believed to be:

MORE than 2000 elective operations to be axed in the '07/'08 financial year

ONE ward being closed at Western Hospital, with patient numbers down by about 100

UP TO 40 people waiting on trolleys each day in emergency departments at Western and Sunshine

AND two of the three pediatric surgeons at Sunshine Hospital are taking leave because their working hours are being slashed.

A Western Health network spokesman confirmed the budget troubles on Friday. Staff in the Western Health network have confirmed the ward closure at Western Hospital. Staff told of there often being "more than 20 people in the Emergency Department on trolleys awaiting admission". AMA Victoria president Dr Douglas Travis confirmed Western Health had over-run its budget. He said: "There is a planned general reduction in services. "Administrators go through great anguish deciding how best to 'cut the cloth to fit'."

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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