Smokers facing hospital operations ban

MARK NICHOLLS Smokers are being ordered to try to quit their habit before surgery or risk losing the chance of an operation as Norfolk's health chiefs introduce radical steps to save money.


Smokers are being ordered to try to quit their habit before surgery or risk losing the chance of an operation as Norfolk's health chiefs introduce radical steps to save money.

Norfolk Primary Care Trust, which is £50m in the red, is one of the first health authorities in the country formally to take the initiative - though other trusts, including in the eastern region, are considering following suit.

The PCT recognises the healthy lifestyle benefits of the move but also makes no secret of the fact that it is introducing the policy as a cash-saver because it says smokers cost more money.

The new regulations, approved by Norfolk PCT, cover non-urgent operations such as hip and knee replacements or hernia operations. They stress smokers needing urgent surgery will not be affected by the policy.

Smokers are being targeted because they are at increased risk of complications and take more time to recover from surgery meaning they have longer - and more expensive - stays in hospital.

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But smokers last night claimed they were being unfairly picked on - and GPs opposed the approach saying it “inappropriately disadvantaged” smokers.

Norfolk PCT's new director of public health Dr John Battersby said: “The situation across Norfolk is that one in four people smokes and that is the same for the proportion of people coming through for surgery. There is increasing evidence that smokers have three times the number of complications as non-smokers.

“What we are proposing is that if someone who smokes is being referred for surgery, we would instead want them to be referred to a smoking cessation clinic and give them three months to stop smoking.”

Complications smokers are vulnerable to after surgery include wounds taking longer to heal - leading to a greater risk of developing infection, particularly chest infections - and blood clots. And for those needing vascular surgery, on blood vessels, the risks are higher - often with a greater likelihood of an artery clogging up again quicker for someone who smokes.

Dr Battersby said: “What we are doing is asking people to have a stab at giving up for three months and at the end we would review the situation. Some people will have stopped and will go on and have a referral for surgery. Others will not have stopped.”

In those cases, decisions will be taken along the lines of clinical need.

The PCT says if smokers have tried hard and need the surgery, they may get it. But if it is felt they have not made a strong effort to stop and are at high risk from the proposed surgery, they may not be referred to the operation at that stage.

Dr Battersby added: “I am not saying there is an absolute block on smokers getting surgery but there is evidence that if they successfully stop smoking they have a much lower risk of developing complications and there will be a better outcome for them.

“There is a cost implication in terms of those complications. If they stop, it is going to have a positive impact on the health system.”

The smoking plan, similar to a scheme in Newcastle-under-Lyme in Staffordshire, was included in finance director David Stonehouse's plan for bringing the Norfolk trust back into financial balance over the next three years.

It is part of a hit-list of cost-cutting measures by the PCT including a cut in the £230m elective surgery budget by £10m as well as cutbacks in prescribing, emergency services and mental health care.

Great Yarmouth and Waveney PCT last night said it was considering a similar approach to smokers needing non-urgent surgery.

Suffolk PCT does not have a similar smoking policy for non-urgent operations but points out that it works with local hospitals to support people giving up smoking ahead of surgery, although it did take steps earlier this year to bar obese people from joint surgery until they lost weight.

But smokers felt the plan discriminated against them.

Nigel Massingham, from Norwich, said: “It is unfair. I smoke and I pay more through tax on my cigarettes than many people and I do not think smokers should be discriminated against like this.”

Mandy Jones, from Diss, said that if she needed an operation she would welcome the opportunity to be helped to give up the habit but added: “If they are going to pick on smokers they should also do the same for drinkers because drinking causes as many health problems as smoking.”

Simon Lockett, secretary of the Norfolk Local Medical Committee representing GPs, said they had not been consulted, adding: “Clearly the new PCT believes it has got to act as quickly as possible because of its financial position but I think GPs would be very concerned about this idea.

“GPs refer people when they think people need to have things done and it would be quite unusual for those who are still smoking for practices not to have done quite a lot of work with them about stopping. In working with the Norfolk Smoking Cessation service, practices have already been getting quite reasonable results.

“Most people who smoke wish to stop anyway and we really do not think it appropriate that they should be disadvantaged by being forced to wait for important operations.”

Linda Caine, who has introduced a number of no smoking initiatives for the PCTs across Norfolk, said: “Other programmes, such as the one at Newcastle-under-Lyme have been successful in supporting smokers to stop a good while before their surgery and they have had positive post-operative outcomes.”

She said any scheme to help smokers stop would also look beyond just quitting the habit and offering other advice such as that concerning diet to help them change their lifestyles.