In King Size Homer, a Simpsons’ episode first broadcast on November 5th 1995, our hero embarks on a quest to reach 300lb so he can be declared legally disabled and thus work from home.
(I think the writers were KLF fans as there is a scene featuring Homer driving an ice cream van whilst wearing a muumuu.)
While he’s on his quest to destination diabetes he garners some valuable advice from Dr Riviera, Springfield’s two buck quack – “Be creative. Instead of eating sandwiches with bread, use pop tarts. Instead of chewing gum, chew bacon.”
In Somerset, on a similar mission, is Sig Lonegren, 67, but he is unlikely to be bolstered by the support of Glastonbury’s Dr Nick.
Mr Lonegren’s Body Mass Index is currently 37. Somerset’s Primary Care Trust has decided that a minimum BMI of 45 is required before they will pay for gastric banding. In other regions, a score of 35 is sufficient to obtain a NHS theatre pass.
Mr Lonegren is outraged at this latest example of postcode lottery. He has decided to embrace positive inaction and has embarked on a sit down food fest in a brave effort to gain that crucial 7.7.
Upon the initial reading, I was a Staffordshire Bull Terrier trying to catch a bluebottle. I was right wing: all the symptoms were there – the surrender to the initial emotional response, the disinclination to pursue the story further and the flashback to the crucial worldview forming moment in the schoolyard that first illustrated that life could be unfair.
But wait. Blustering is the handmaiden to prejudice so let us probe deeper.
At first, it is difficult to feel a lot of sympathy for Mr Lonegren. Although he has tried twenty diets, has diabetes, blood pressure problems and high cholesterol, there is a belligerent tone to his words when he outlines his plans for expansion – “My only option is Mc Donald’s and Ice Cream – pay up or pig out.” In the words of the Somerset PCT spokesperson, it is dangerous and misguided.
Somerset PCT also denied it made the lower limit 45 to save money.
A BMI of 45 is the upper limit of the “morbidly obese” band. The National Institute for Clinical Excellence has published guidelines stating surgery should be recommended in cases when BMI has reached 40 – or, when it is over 35 and the patient has obesity related diseases, criteria that apply to our man in training. Crucially, however, the government did not allocate a specific chunk of change to cover the costs of the surgery or set up a national network of surgeons.
It’s the economising, stupid
The NICE guidelines also stipulate the patient should be strongly motivated to undergo the surgery and be mentally prepared for the lifestyle changes that will ensue – one could possibly argue that would be a stumbling block for Mr Lonegren – however, he deserves a proper assessment.
In King Size Homer a wise guy remarks “I heard that guy’s ass has its own congressman.”
(I think the writers were KLF fans as there is a scene featuring Homer driving an ice cream van whilst wearing a muumuu.)
While he’s on his quest to destination diabetes he garners some valuable advice from Dr Riviera, Springfield’s two buck quack – “Be creative. Instead of eating sandwiches with bread, use pop tarts. Instead of chewing gum, chew bacon.”
In Somerset, on a similar mission, is Sig Lonegren, 67, but he is unlikely to be bolstered by the support of Glastonbury’s Dr Nick.
Mr Lonegren’s Body Mass Index is currently 37. Somerset’s Primary Care Trust has decided that a minimum BMI of 45 is required before they will pay for gastric banding. In other regions, a score of 35 is sufficient to obtain a NHS theatre pass.
Mr Lonegren is outraged at this latest example of postcode lottery. He has decided to embrace positive inaction and has embarked on a sit down food fest in a brave effort to gain that crucial 7.7.
Upon the initial reading, I was a Staffordshire Bull Terrier trying to catch a bluebottle. I was right wing: all the symptoms were there – the surrender to the initial emotional response, the disinclination to pursue the story further and the flashback to the crucial worldview forming moment in the schoolyard that first illustrated that life could be unfair.
But wait. Blustering is the handmaiden to prejudice so let us probe deeper.
At first, it is difficult to feel a lot of sympathy for Mr Lonegren. Although he has tried twenty diets, has diabetes, blood pressure problems and high cholesterol, there is a belligerent tone to his words when he outlines his plans for expansion – “My only option is Mc Donald’s and Ice Cream – pay up or pig out.” In the words of the Somerset PCT spokesperson, it is dangerous and misguided.
Somerset PCT also denied it made the lower limit 45 to save money.
A BMI of 45 is the upper limit of the “morbidly obese” band. The National Institute for Clinical Excellence has published guidelines stating surgery should be recommended in cases when BMI has reached 40 – or, when it is over 35 and the patient has obesity related diseases, criteria that apply to our man in training. Crucially, however, the government did not allocate a specific chunk of change to cover the costs of the surgery or set up a national network of surgeons.
It’s the economising, stupid
The NICE guidelines also stipulate the patient should be strongly motivated to undergo the surgery and be mentally prepared for the lifestyle changes that will ensue – one could possibly argue that would be a stumbling block for Mr Lonegren – however, he deserves a proper assessment.
In King Size Homer a wise guy remarks “I heard that guy’s ass has its own congressman.”
Back in Blighty it seems precious few MPs are supporting the case of Mr Lonegren. Indeed, there is a growing movement for a debate about whether certain, expensive surgeries, should be funded by the NHS at all, especially in case when individuals have been reckless or unlawful. This is a discussion worth having but why the sudden emergence of New Labour MPs keen to seek precious airtime on this topic?
In 2003, the government negotiated a new contract with the British Medical Association to ease tensions in the NHS, to prevent staff losses and to make conditions more bearable but, in the words of Dr Hamish Meldrum of the BMA, “There were areas of the package where big concessions were made”.
In poker parlance, the Government overplayed their hand, dumped their chips on the table and chortling GPs were left to rake it in.
For GPs to opt out of seven-day patient care cost only 6% of their contract: they were expecting to lose 50%.
They thought the contract “was a bit of a laugh”.
This signed the death sentence of out of hours care to the extent that only eight of London’s surgeries are available for Saturday appointments. It is just not worth the GPs’ time.
It is now common to bus in weekend doctors from other parts of the EU and pay them three times the hourly rate they earn in their own country. At the height of this haemorrhage, one doctor earned £10,000 for agreeing to work over the Easter weekend. Suddenly criticisms of Mr Lonegren’s goal oriented face stuffing, for surgery that costs an average of £9,000, look a bit misplaced. According to Professor Alan Maynard, a health economics expert at York University, “These pay increases are creating deficits, undermining patient care and the financial performance of the NHS.”
The first year of the renegotiated contract cost the NHS an estimated £70 million but don’t blame the GPs – like Mr Lonegren, they are simply working towards a goal as they now have performance, if not patient, related pay with the Quality and Outcomes Framework.
There is a computer registrar of QOF points. These have translated to cash, the growth of healthcare IT consultancies outlining ways for surgeries to up their income, and the decline of doctor patient relationships. Even without expert advice GPs outperformed government expectations - wonks thought surgeries would hit only 70% of the targets – in fact, they hit 90%.
Target setting clearly works according to Gill Morgan, the Chief Executive of the NHS “We were aiming to give a 30% pay rise over three years. It was 30% in one year. Every pound that goes somewhere you don’t intend it to go is a pound not spent on patient care.”
The combined cost of QOF and paying for doctors to staff out of hours surgeries last year was £250 million. That is half of the NHS deficit.
There are ten Homer Simpson characters currently noshing through nosebags as they attempt to hit their own magic targets, bravely foraging for excess without the aid of consultancies and with only snack food advertising to keep them focused. The combined cost of their gastric banding is £150,000, a fraction of the new bill for surgery administration.
If successful they will have to endure the side effects of bloating and copious gas, so if they can then just learn how to dump cash, Camp Westminster beckons.
In 2003, the government negotiated a new contract with the British Medical Association to ease tensions in the NHS, to prevent staff losses and to make conditions more bearable but, in the words of Dr Hamish Meldrum of the BMA, “There were areas of the package where big concessions were made”.
In poker parlance, the Government overplayed their hand, dumped their chips on the table and chortling GPs were left to rake it in.
For GPs to opt out of seven-day patient care cost only 6% of their contract: they were expecting to lose 50%.
They thought the contract “was a bit of a laugh”.
This signed the death sentence of out of hours care to the extent that only eight of London’s surgeries are available for Saturday appointments. It is just not worth the GPs’ time.
It is now common to bus in weekend doctors from other parts of the EU and pay them three times the hourly rate they earn in their own country. At the height of this haemorrhage, one doctor earned £10,000 for agreeing to work over the Easter weekend. Suddenly criticisms of Mr Lonegren’s goal oriented face stuffing, for surgery that costs an average of £9,000, look a bit misplaced. According to Professor Alan Maynard, a health economics expert at York University, “These pay increases are creating deficits, undermining patient care and the financial performance of the NHS.”
The first year of the renegotiated contract cost the NHS an estimated £70 million but don’t blame the GPs – like Mr Lonegren, they are simply working towards a goal as they now have performance, if not patient, related pay with the Quality and Outcomes Framework.
There is a computer registrar of QOF points. These have translated to cash, the growth of healthcare IT consultancies outlining ways for surgeries to up their income, and the decline of doctor patient relationships. Even without expert advice GPs outperformed government expectations - wonks thought surgeries would hit only 70% of the targets – in fact, they hit 90%.
Target setting clearly works according to Gill Morgan, the Chief Executive of the NHS “We were aiming to give a 30% pay rise over three years. It was 30% in one year. Every pound that goes somewhere you don’t intend it to go is a pound not spent on patient care.”
The combined cost of QOF and paying for doctors to staff out of hours surgeries last year was £250 million. That is half of the NHS deficit.
There are ten Homer Simpson characters currently noshing through nosebags as they attempt to hit their own magic targets, bravely foraging for excess without the aid of consultancies and with only snack food advertising to keep them focused. The combined cost of their gastric banding is £150,000, a fraction of the new bill for surgery administration.
If successful they will have to endure the side effects of bloating and copious gas, so if they can then just learn how to dump cash, Camp Westminster beckons.
No comments:
Post a Comment