Sarah-Kate Templeton, Health Correspondent
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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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i pay my national insurance every week and i thought this was for any medical care i required on the national health. if i am going to be singled out as a smoker or if i was over weight, is this not taking money out of my wages illegal as i am not getting the service that i am paying for. i am a smoker and in my 54 years i have been in hospital twice and not smoking related, i also visit my gp on average once every 2 or 3 years and have never been for a smoking related illness.
stephen hendry, scunthorpe, north lincs
"Our purpose is not to deny patients access to operations but to see if the outcomes can be improved.
Rubbish! How stupid do these people think we are? It's all a new way that allows the goverment to massage the waiting times for routine opperations. Without even adressing the issues of those who social smoke, or who've quit but occasionally relapse and have that one fag.
And what about all the people who drink too much? We're going to deny them access to propper health care too? And drug addicts? And obsese people? Andanadand.
Esther Harper, Bonn, Germany
At least the NHS are given people a choice: quit smoking or you may not receive life saving treatment. It gives an entire new meaning to the phrase 'smoking kills!'
The NHS is there to serve the people, not to refuse the individuals who need help the most until they quit a legally backed and perhaps entirely unrelated activity.
It may cost them a little extra money in recovery time, money which as others have stated has been payed by smokers in taxes many times over, yet since when did the NHS start putting a monetary value on a human life... and decide that in certain circumstances it might be too expensive.
Kat Slowe, Dorchester, UK
It's very reassuring to see others recognise this witch hunt lunacy for what it is.
Well said Rufus, that's the nail on the head.
How about banning the drinkers from any medical attention to their livers? What about use of illegal substances? Here's another one, vegetarians. They don't eat meat so why not ban them too? How would they feel?
This pathetic excuse that smokers take longer to heal is absolute bunkum. There are no FACTS to prove this categorically or that smoking leads to cancer. I've known many die from cancer who never touched a cigarette, and even more who smoked since their teens and lived to a ripe old age.
This whole no smoking lark is nothing more than a wholely unjustified witch hunt. Segregation gone mad. What next? People with bad teeth (me) are vile and shouldn't go to a dentist?
I wonder what the next pathetic excuse to divide the people will be?
This exclusion is nothing more than discrimination, which I thought was against the law!
Colin Nunn, Newcastle upon tyne, Tyne & Wear
When you consider the National Insurance a smoker has paid in over 40 years together with the incredible tax on tobacco, he has paid enough for a private ward.
Terence, Alcala, Spain
If the NHS can opt-out of treating fat people or smokers, when we will be able to opt-out of funding the NHS?
Tony G, Harrogate, UK
Vanessa Bourne's job is sponsored by a Private Health company who obviously want as much bussines in the form of patients needing surgery.
Of course she will slag off her competitor,( the NHS!).
jayne Biddiscombe, somerset, uk
Well actually what they are saying is that by stopping smoking you will have less morbidity from the proceedure - boy you lot moan on when anything occurs. Cannot you not see the reasons - its to help you recover better - with less time in hopsital and a more sucessful proceedure. If that is not what you would like - please continue somoking -just no complaints when you recover slowly and do less well post-op.
Graeme, Melbourne, Australia
Far greater savings could be realized if treatment were also withheld from persons who choose to engage in sport, at least for those injuries and conditions caused or aggravated by these activities. All of us have made poor choices - why should one particular choice, however bad, be punished by an added three months of limited mobility, pain (and painkillers), and restricted activity on the job and at home.
One also wonders how the stress of quitting smoking, or of failing in this often impossible goal, contributes to recovery from surgery.
While we might all wish that no one smoked, that horse left the barn centuries ago.
David, Cincinnati, USA
This is a sensible proposal. I believe there should be further restrictions on people whose lifestyle would be detrimental to any surgical outcome.
Why not also require people to give up alcohol and lose weight . We should also consider withholding treatment for anyone who is older than the national average lifespan.
Such a regime would be good for taxpayers and very good for the private medical industry in which I will be purchasing shares when the markets open tomorrow
Don , Coventry,
If it is the case that smokers are to be denied treatment then so be it.
I contribute far more to the NHS than I take out, I'm a regular blood donor, a smoker (so I'm more than self-funding for them) and I've been to hospital fewer than once a year, almost exclusively as a result of sporting injuries.
No more.
No more subsidising the NHS under those lunatics. My tobacco will from now on come from other EU countries. Let them benefit from the stupidity in this country. And the only blood that they're likely to get from me will be dripped on the floor of A&E, and I'm binning the donor card that I signed on my 18th birthday and have carried with me ever since.
While I can see that tobacco is now what witchcraft was in the 16th century, the fact that the implication that treatment will be withheld regardless of whether or not the condition is smoking related is intolerable for a SERVICE that I am paying, and paying over the odds, for.
Rufus, Oxford, UK
Vanessa Bourne appears to have hit the nail on the head.
Smokers have become an excuse-all for the NHS and DoH.
Chris, Cornwall,
NHS managers want to deny treatment to smokers because recovery will take longer. I'm sure they are correct in that. It is a sound business decision.
It is also sensible because even if these smokers need treatment they won't be added to waiting lists, so effectively will be invisible. They won't exist - convenient for targets.
Businesses exist to get results,maximise profit and reduce cost, but, forgive my naivety, I thought the NHS was supposed to give health services to the nation.
No one denies smoking is bad for your health, but the educated middle classes are better at not starting, or giving up, than the poorer, less educated classes. They have healthier lifestyles and have less need for healthcare than poorer people, and going private is less of a problem.
So even if it is not the intention, adoption of these ideas will discriminate against precisely those groups who most need free healthcare.
Are we returning to the Victorian concept of the undeserving poor ?
Nick Moore, Saint Ouen, France
OK, Peter, in Belfast...
smoking causes blood vessels to narrow,decreasing amount of oxygen to the healing area.
smoking decreases amount of oxygen in the blood. healing tissues need oxygen.
Smoking decreases formation of collagen, which is like a connective tissue type of stuff...necessary for healing tissues ti knit together.
Smoking increases production of CYANIDE in the bloodstream, this makes it harder for the chemocals in the body to transport any available oxygen to the healing area.
Jayne Biddiscombe. Nurse, Coronary care.
jayne Biddiscombe, somerset, uk
First they came for the smokers, and I didn't speak up because I wasn't a smoker... I'm just thankful we have no such abomination as the NHS in our country. Yet.
Reid Reynolds, Herndon, Virginia/USA
i would like to see the study this was based on i.e. smokers take longer to heal,have more complications etc
peter, belfast,
Not sure why this is only going to impact those who smoke. What about the obese or are we supposed to believe that the current epidemic is caused purely by defective genes rather than doing no exercise and eating rubbish.
Stephanie, London, England
It's all very well targeting smokers but what about other self inflictied addictions. Is the NHS going to deny for example drug addicts and alcoholics treatment as well. I am a non smoker drink very little and don't do drugs. I also agree with Vanessa Bourne that hospital aquired infections need to be tackled as a matter of urgency.
Jules, Sheffield, England
If patients were fed decent food or, in some cases, food at all they would recover faster. Too much like rocket science for the NHS though.
eddie reader, bimingham, uk