As a rather plump NHS campaigner bedevilled by man boobs, I was given two good reasons to baulk at the recent announcement by The Vale of York CCG that they intended to restrict obese patients’ access to elective surgery until they lose weight. This cost-saving measure was their seemingly pragmatic response to Jeremy Hunt and friends’ systematic starvation of NHS funding. Indeed, since the Vale of York was in special measures, NHS England had to intervene to ask them to rethink such an extreme move. And you know you’re in trouble when NHS England tell you you’ve gone too far – the medical equivalent of Rupert Murdoch lecturing you on leaving people’s phones alone. However a few days ago NHS Harrogate and Rural District CCG announced that they will deny operations to the obese and smokers for six months as a ‘cost-cutting move’.
And my first thought on reading this was ‘Easyjet’.
Why? A year ago I was in the departure lounge awaiting an Easyjet flight to Italy for a conference talk I was giving. I got to the front of the queue to get a good seat. I was pleasantly diverted from the wait by a couple quarrelling over how much space his flippers were taking up in their suitcase. She said that she hoped he’d get eaten by a shark because that would teach him. He replied that sharks didn’t eat people in flippers because the flippers made people look like fish. I was thoroughly enjoying this exchange when I was jolted by the news that I was unable to board the plane. Indeed me, two businessmen and the flipper couple were ejected from the departure lounge despite having valid tickets. Apparently, common airline practice is for airlines to overbook seats on flights on the (usually true) assumption that some passengers won’t turn up and so they won’t fill their seats. One suspects that rather dastardly economic modelling has revealed to these little aviation Machiavelli’s that the cost of paying compensation for the few times that everyone actually turned up was less than the cost of flying below capacity flights.
That such a practice is morally, if not legally corrupt has obviously not been a prime concern. I don’t imagine there is a world record for the number of times a human being has said the words, ‘but I’ve paid for my ticket’, but if there were then I think I must have come close.
I had paid.
Following a complaint letter that included 21 swear words and the use of a coarse monkey sex allegory to describe the practices of the Easyjet board (not my finest moment), I moved on. Or at least I did until I read about our friends at Vale of York and Harrogate.
You see, the problem is that general taxation still accounts for around 80% of all NHS funding. Many of the people who will be turned away after the (utterly unreliable) BMI ushers them unceremoniously toward the wrong side of an absurd medical apartheid would have paid general taxation for years for just this eventuality- medical care when they need it. And what about the athletes, the weightlifters and sportspeople whose muscle mass tips them over the BMI level? Perhaps they can just take their tops of to reassure medics that they are not, in fact, overly plump. Is this how it will work?
And all because a small group of commissioners in Harrogate, some of whom, I have to say look like they might set off a BMI alarm bell or two themselves, have decided to turn their back on 60 years of universal, comprehensive, free at the point of delivery tax-funded healthcare in order that they can take part in the great NHS defunding jamboree that is befalling our nation.
Presumably, their intention is to ask GPs and consultants to spot obese people, measure their BMI, and let them know whether they qualify for the surgical procedure that they both needed and have, for many years, paid for.
One assumes that it will be the doctors and nurses themselves who will have to sit down and explain to vulnerable patients why it is that, despite years of loyally paying their taxes, through good times and bad, they find that the universal, comprehensive, free-at the point of delivery National Health Service is suddenly rejecting them. Easyjet economics shoehorned into the world of neoliberal medicine. That strikes me as a pretty difficult conversation for a doctor to have with a patient.
Now another difficult conversation that could have been had would have been for the Harrogate commissioners to take a long hard look at themselves in the mirror and start a desperately-needed conversation with NHS England, with our nominal Secretary of State and with local people, to tell them that the systematic starvation of funds means they can’t do the job they are meant to do. They can no longer provide healthcare for the people of Harrogate. They could contact other CCGs and work together to start a much needed conversation about the way that the NHS is being run into the ground, about the people who will die as a result of this and about how CCGs, hamstrung by an unworkable and undemocratic framework which forces them to push contracts to the profit making sector, while cutting essential life-saving health services, are increasingly helpless in their attempts to hold our NHS together.
The Vale of York CCG said it had taken the decision because it was the “best way of achieving maximum value from the limited resources available”. In future they may wish to consider that another way of achieving maximum value from limited resources would be to use their expensively salaried positions to stand up for the people they commission for.
A version of this blog post previously appeared on the Friday Surgery section of the National Health Action Party blog. It is adapted and reproduced here under creative commons licence.