Monday, 7 February 2011

Big Problems

Remember this post about drunkenness, and the discussion it generated? I still don't have the answers, but I'm always coming up with more questions!

So, here's another one. Go read the following article and watch the video, then come back.

How do we deal with another one of society's big problems? And yes, the pun was intended. These ambulance and hospital adaptations are not for the almost run-of-the-mill 100+ Kilo (220+ pound) patients. A two-person crew will regularly need to carry these sorts of patients down a flight of stairs. 

These specialised beds, equipment and ambulances are for patients double that, sometimes, as the report suggests, even triple and more. I sat listening to an overnight radio presenter talking about it, and listeners calling in adding their suggestions, frustrations and solutions. As usual, there were the calls for these patients to pay for their specialised care, or be refused it. Passions ran high between those who have clearly never experienced the problem, and those who face it on a daily basis. People were claiming that as morbidly obese patients bring their condition upon themselves, they don't deserve free NHS treatment, whilst the obese themselves (by their own admissions, this was radio after all), claimed that life-style choices are not the benchmark by which the NHS allocates treatment.

So I ask again.

What about smokers who suffer lung cancer as a direct result of their habit?

What about extreme sportspeople who get injured in their pursuit of adventure?

What about drunks who fall and crack their heads open due to their intoxication, be it acute or chronic?

Do we bar all of them from free treatment, as these are all self-inflicted?

The NHS is still, for the most part, a free service, and proudly calls itself the envy of the world. Its staff, for all their grumbles, are proud of what they do and are dedicated to it.

But everything comes at a cost.

For every bariatric ambulance, somebody, somewhere, will be denied some other treatment.

And whilst the ambulance in this report seems to have all the equipment, there's still one glaringly obvious omission.

What happens when there's a flight of stairs to contend with?

What about the physical cost to the crews?

I only have the questions, and an undecided mind.

Answers are another thing all together.  Education is clearly one of them, as with everything else, but over and above that, I really don't know.

Do you?


Anonymous said...

This is certainly a weighty problem (another deliberate pun). However, whilst some conditions are indeed self inflicted, obesity is in some cases genetic. Not every book should be judged by its cover and, until the underlying cause is established, no doubt you will continue to serve all who need your service.

Keep up the excellent work and blogging.

1st time commentator.

You ask about the flight of stairs and the physical cost to the crews. Presumably you all know your limitations in any given circumstance and will know when to call for assistance, say,from the fire service. Yes, there is an additional cost but the first consideration will no doubt continue to be the patient to whom you will endeavour to render the best possible care in any given circumstance.

Free treatment should be available to all but after the event and with background knowledge of the sick or injured party you have assisted, there should be a debrief and, if self infliction is deemed to be the cause (eg the drunk or extreme sportsperson) financial recompense should, perhaps, be pursued by the NHS.

Anonymous said...

It wouldn't be easy to charge these people for the extra costs of their transport, so we need another approach. Time to put 40% VAT on all foods with a high fat or sugar content perhaps? If that money went directly to covering the costs of treating & educating these excessively large people (how to cook real food, & the dangers of a poor diet), would that help? It wouldn't hurt anyone's waistline to have fewer pizzas, burgers, or bars of chocolate, & if these foods were more expensive than some healthier ones, it might make some people think.

Fee said...

I'm reluctant to say anyone should be charged more for NHS treatment based on a perception of "self inflicted injuries".

I'm the kind of skinny lass who wouldn't exactly challenge the paramedics to lift, I don't smoke and hardly drink. I would object to anon's suggestion above purely because I love chocolate. Why should I pay more when I don't have a particular reason to avoid the stuff? Also, increased taxation on cigarettes hasn't stopped folk buying them.

So, in other words, I don't have the answer.

Pie said...

Fascinating again! Such a difficult question. I do think that ultimately, people who need treatment need treatment, and that's that. However, it is a really big problem.

I think that really, people need to be more educated, and from a younger age, about the costs of health care. I believe a big barrier to people understanding the NHS and treating it with a bit more respect is that they just have no knowledge or understanding about how it works and what it costs.

Also, I think there needs to be more of a culture of prevention...

Anonymous said...

The smoker and drunk pay so much tax, they have paid for their ambulance fare. The question is, has the fat bloke?

Girliebob said...

OK, so this one may have hit a nerve with me because I'm a larger lady. But having said that I'm a larger lady who quit smoking 4 years ago, doesn't drink and exercises regularly - so I'm not exactly the couch potato people assume me to me.

BUT, I've been working since I left college *mumbles* years ago, and have (touches wood) never had the need to call on the service of a passing ambulance.

So, what makes me any less entitled to use an ambulance when I've been paying tax and national insurance for years than my skinny young neighbour who has three children by three different fathers and has never worked a day in her life?

I'll stop playing devil's advocate now and go back to sitting on the fence!

Anonymous said...

I carry about three stone more than I should. I am also a t2 diabetic- some would say that I am diabetic because of my lifestyle. But equally I have a strong family history of it.
My point is, if treatment were to be denied to those with problems that they may have contributed to, where would that start? Me? (who for the record has never required an ambulance), the person that is 5 stone overweight? Ten?
Or how about those frequent flyers? Those that abuse the system? I have no idea either.

InsomniacMedic said...

First - thanks for your comments.
Secondly - I'd like to reply to you all, so I think there will have to be another post on the subject. Some extra points have been raised, and so I'll throw them into the mix soon...
Watch this space!