Sunday, 11 November 2012

Super-Sized Hospitals

You may have picked up on a theme in this blog that I think one should actually budget one's expenditure against one's income. This is as true for a country as it is for an individual. If you can't afford a new car, don't buy one. If you can't afford a new warship, don't buy one. Or of course, if you think you really need it (car, warship, whatever) more than something else, don't buy that instead. This is not revolutionary.

Which leads me to an article I saw recently bemoaning the fact that "hospitals are inadequately prepared to deal with extremely fat patients". Hospitals are probably inadequately prepared to deal with bombs going off outside them sending hundreds of victims to A&E simultaneously. Or some Hollywood viral epidemic. Lots of things really. Because they have budgets. Which we pay for. So they try to cover most eventualities, most of the time to give a good level of healthcare to the most people. That's the idea.

The article I read focused on a report in the Bulletin of The Royal College of Surgeons of England. It suggested many hospitals were in essence failing fat people - morbidly fat people - by not spending their (ironically) hugely bloated, but still limited resources on providing super-size stuff. Don't know about you but providing a bed that can take more than 28 sodding stone (the current limit of normal NHS beds), or as I like to call it, a small family, is lower down my 'to spend on list' than cancer treatment. So is providing wheelchairs which can take more than 25 stone. Or examination couches designed to take more than 21 stone.

There's certainly an argument that says taking a morbidly obese person to a veterinary hospital to be scanned in a horse MRI machine because they don't fit in the human one at the hospital is a good thing. That might be the kick in the capacious rear required to convince the person in question that losing weight might be an idea. But then I hear the caterwauling about dignity and human rights and other such tosh. You can see which way I lean but I certainly understand it may not all be black and white.

One can certainly argue over the fairness of costing the system lots of money (and thus costing the taxpayer lots of money) by intentional lifestyle choices. When it comes to obesity, you will get ill if you eat too much. Your body can't deal with the cholesterol, the fat, the extra weight on bones and joints etc. We aren't designed that way. And most people who are very fat (the vast majority - no pun intended) chose to be so. I don't mean they get out of bed and say, today I choose to be fat. I mean they choose to eat too much, too unhealthily and not exercise enough. There will be various reasons for going down this road, but it generally boils down to a choice.

It's about willpower. Go to any AA meeting. One of the keys to sobriety is acknowledging you can choose not to drink - you have the power, not the drink itself. Drinking or not drinking is the choice you make. Some will find it easier, some harder to make the 'right' choices. Some will be more prone to making poor choices, some will see it as the only choice, an escape - people who eat/drink/take drugs to get away from something. This is a running theme. The point still remains you intentionally do bad things to your body and John Q. Taxpayer picks up the financial bill.

As you see, the argument is not restricted to obesity, or even drugs and alcohol abuse. One could argue about the fairness of those others who place themselves in harm's way intentionally and expect the NHS to cover the costs - people who play contact sports, racing drivers, parachutists - you see where I'm going with this. The private sector answers this apparent inequality by assessing the risk of your need to claim based on your lifestyle and charging premiums accordingly. The non-smoking healthy jogger gets charged less than the free climbing coke addict. That's from each according to his likely need. That's not the NHS.

The NHS is about trying to fix people whatever, and if you pay your taxes but never need healthcare, bully for you, because you have your health. Which is very noble. But it's not affordable to provide 'total medicine' - every known cure, treatment and facility for everyone and hang the cost. So, I shall leave the question to you to mull over whether we are getting it right morally by funding unhealthy lifestyles. Are we encouraging this 'bad behaviour' by subsidising it? Maybe we have no right to say how people should live? Maybe we do if we are paying for that lifestyle? It is, I am certain, a divisive subject with good arguments on both sides.

What cannot be ignored though, is in a world where we cannot afford all things, we must prioritise. And I think there are going to be a great many things people want money spent on in the NHS before they want titanium re-inforced chairs for the obese. This is for the very same reason that increasing military funding in years when the nation is in no obvious direct threat is not a vote winner.

Especially today, Remembrance Sunday, we can see the gratitude and depth of feeling we in this country have for our servicemen, past and present. However, when it comes to Government spending almost everyone has an interest in the NHS (we all have a granny needing a hip replacement, or at least want to know there's an ambulance waiting to take us a well-equipped hospital should we have an accident), and 93% of us have an interest in public education (because that's where little Johnny will be going to school). But there are only about 150,000 military personnel in this country. When it comes to voting, we get selfish.

So I say, yes, we do need to recognise that our country's weight issue is spiralling out of control. Our morbidly obese has risen threefold in 20 years and is showing no sign of abating. We have huge issues will childhood obesity as we eat more unhealthily and become more sedentary with Xboxes beating playing in the garden. But whilst have to recognise the increasing girth of our population, I do not think the answer can be to simply accommodate it, not least because we have more important things to spend the money on, and not just within the NHS.

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