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NHS: Denial of Treatment

Volume 692: debated on Wednesday 6 June 2007

asked Her Majesty’s Government:

Whether they will review the denial of some National Health Service treatment to certain obese people and smokers, given that treatment is provided to drug addicts, alcoholics and those suffering from anorexia.

My Lords, it is for doctors, in consultation with patients and their families, to determine the care that is clinically appropriate for each patient, based on an individual assessment of need and of the risks and benefits of all available treatment types. This assessment will take into account lifestyle choices that may affect the efficacy of treatment.

My Lords, that is a marginally helpful Answer, but by what right does the noble Lord, as a senior Health Minister, decide that the 25 per cent of adults who smoke and the millions of people who are technically obese—all of whom have paid their taxes and national insurance—are to be denied National Health Service surgery, as has been stated by Leicester City West PCT, and are to be taken off the waiting list, as they are by Norwich PCT? Other PCTs are also taking discriminatory action. In the light of that evidence, will the Minister exercise his authority under the NHS Acts and instruct all PCTs to stop such discrimination forthwith?

My Lords, the noble Lord asked me by what right I do this. I do not believe that I have exercised any such decision in relation to his question. The proposal of the Leicester PCT to which he referred came from the professional executive group of clinicians. It has not been agreed by the PCT and will be subject to public consultation. My understanding is that there is no proposal for a blanket ban on surgery. What is happening is that patients due for non-urgent surgery will be offered pre-operation smoking cessation advice. The operation would be deferred while smokers were given an opportunity to access that advice. The reason for that is the balance of risk and advantage. Stopping smoking would lead to those patients experiencing a reduction in heart and lung complications, faster wound healing, faster bone fusion times and a reduction in the length of stay in hospitals. At the end of the day, it is an issue of clinical judgment based on the balance of risks and benefits; it is not a matter for Ministers.

My Lords, would it be right if the same criteria were to be applied to those whose sexual habits made them vulnerable to particularly unpleasant sexually transmitted diseases? Would they be expected to give up those habits to obtain treatment?

Of course not, my Lords. The noble Lord is quite ridiculous in asking that question. In the public interest, at the very least, sexual disease should be treated. That is a completely different issue. The issue that we are considering is advice from doctors to a public health authority that has not yet been agreed. It states that for smokers there are different balances of risk in certain operations and that offering smoking cessation services to those people before they have an operation would be in their best interests as well as anyone else’s. I am content to abide by the judgment of clinicians, whose number one consideration is the interest of the individual patient.

My Lords, is the noble Lord not describing a blanket policy, rather than a patient-specific decision?

My Lords, it is not a policy; this is a recommendation from an advisory committee of clinicians. My understanding is that the recommendation has not been formally considered by the PCT and that it will be subject to public consultation. I have received an assurance that it is not a blanket ban on surgery, but it is not unreasonable for a PCT to develop a general policy for smokers, provided that, in the end, it comes down to an individual clinical decision. The clear evidence seems to be that it is better for a patient to stop smoking before they have an operation.

My Lords, is the Minister saying that if someone indulges in an activity that is damaging their health and may make the treatment less effective, there is a possibility that they will not be treated, but only in those circumstances and on an individual basis? Is that the full extent of the guidance?

My Lords, that is certainly my understanding. The noble Lord put the point very well. However, this is not an agreed policy by the PCT. I refer him to evidence from the London Health Observatory, which showed that if smokers stop smoking before surgery, there are short-term benefits: a reduction in lung and heart complications, faster wound healing, faster bone fusion time and a reduced length of stay in hospital. It does not seem unreasonable for the PCT concerned to ensure that clinicians, using their clinical judgment, are able to offer smoking cessation services to those patients. In the end, it has to be an individual clinical judgment.

My Lords, I hear what the Minister said and I understand it but surely he realises that there is an impression that there is a witch-hunt against smokers in particular. There are all sorts of activities that, if stopped, would save the National Health Service money and ensure that people got better treatment. He understands—I hope that the medical profession and the PCTs do, too—that smokers pay a huge premium through cigarette tax for the treatment that they receive. They are entitled to at least the same treatment as others who pay tax.

My Lords, as an only recently reformed smoker, I fully accept what the noble Lord said. This is not health fascism; this is not about discrimination against smokers. This is about what is in the best interests of the patient in terms of clinical judgment; that is how it should remain. It is important that any policy that is agreed by a PCT in this area should be subject to full public consultation. I have no doubt that it is important that PCTs listen to what noble Lords say but, at the end of the day, I am satisfied that these discussions involve issues relating to what is clinically best for individual patients.