The Royal College of Surgeons has hit out at cost-cutting plans to ration who can receive hip and knee replacements.
Three clinical commissioning groups (CCGs) in the West Midlands have proposed slashing the number of people who qualify for hip replacements by 12% and introducing a 19% cut over who is eligible for knee replacements.
Under the new rules patients would now need to have such severe levels of pain that they cannot sleep or carry out daily tasks to qualify for an operation. Board papers reported by the Health Service Journal suggest an “opportunity to reduce expenditure on hip and knee replacement surgery” by £2m a year.
This would include only treating “severe to the upper end of moderate” cases, and people who are obese with a body mass index of 35 or over who need to lose 10% of their weight unless their problems were very severe.
Documents said a “patient’s pain and disability should be sufficiently severe that it interferes with the patient’s daily life and/or ability to sleep”.
Redditch and Bromsgrove, South Worcestershire, and Wyre Forest are the CCGs that intend to change their scoring system for eligibility, hoping to prevent about 350 operations needing to be carried out each year. But the Royal College of Surgeons has said there is “no clinical justification” for their plans.
The move is the latest in a round of cost-cutting by CCGs – with some slashing access to treatments, expensive drugs and IIVF despite guidelines from the National Institute for Health and Care Excellence (Nice).
Stephen Cannon, vice president of the Royal College of Surgeons, said: “We appreciate that the CCGs face significant financial challenges, which now mean they are looking at which groups of patients they can target to save money.
“While the CCGs have stated they hope this policy will save them £2m a year, it is unclear whether they have considered the costs of not treating a patient. This could include the cost of pain relief medication and a later operation when the patient does meet the required pain and weight thresholds.
“Delaying access to surgery also adversely affects a patient’s quality of life and surgical outcomes, meaning the operation may not be as beneficial as if it had been carried out earlier.”
He said the scoring system used by the CCGs – known as the Oxford scoring system – were designed to measure outcomes of care and “should not be used to create barriers to care”.
He added: “Such criteria are in explicit contravention of Nice and surgical commissioning guidance, and have no clinical justification in being applied to a general population to determine who gets NHS treatment. This policy is the latest demonstration of how NHS financial pressures are directly affecting patients.”
Paul Green, from Saga Group – which focuses on needs for over-50s, said: “To suggest that it is acceptable for people to have to wait until they are unable to sleep before they are eligible for an operation is an outrage, how would these people feel if that was their mother or father or grandparent?
“Remaining mobile is fundamental for people’s mental as well as their physical wellbeing, it appears an unkind cut and the bean counters should examine their conscience.”
A spokesman for NHS Redditch and Bromsgrove CCG said: “The Oxford scoring system is a guidance for clinicians and they recognise that many patients will benefit from physiotherapy and weight loss before considering surgery.
“If a patient feels that they require this surgery but do not meet these criteria, there is a clear appeals system via individual funding requests whereby the effects can be considered upon the patient and the decision made regarding eligibility for funding.”
Surgeon conducting hip substitute surgery. Photograph: Niall Mcdiarmid/Alamy
Experts have raised issues about the use of cement in partial hip replacements – saying it could carry a chance of a patient dying or their heart stopping.
Although these events are rare the issue even now warrants investigation, the researchers stated.
Their comments come right after an examination of the situations of acute patient deterioration linked with hip hemiarthroplasties with the use of cement to support hold the artificial hip joint in area.
A hip hemiarthroplasty is an operation used to replace the upper portion of the femur following a individual has fractured the neck of the femur.
Among 2005 and 2012 there had been 62 reviews of death or significant harm associated with the procedure in the NHS in England and Wales – one particular event for every two,900 operations carried out, they discovered.
This sudden deterioration is referred to as bone cement implantation syndrome (BCIS). In every of the instances studied it caused death, cardiac arrest, or peri-arrest – significant deterioration in the patient’s situation.
Of individuals 62 individuals, 41 of them died and the remainder had to be resuscitated from cardiac arrest or peri-arrest, the authors of the study said.
Most of the reviews describe “acute deterioration” within just a handful of minutes of the insertion of cement, with 80% of the deaths occurring on the operating table.
Considerations had been initial raised about the use of cement in 2009, the authors mentioned in the examine published in the journal BMJ Open.
The Nationwide Patient Security Agency raised the alarm about the use of cement in the operation and issued advice to the NHS on how to minimise the risks.
But 3 quarters of the instances studied happened after this date of this warning which “clearly demonstrates that the implementation of mitigation measures set out in the alert was suboptimal, or that their effectiveness is suboptimal, or both.” The researchers added: “Cement use in hip hemiarthroplasty for fractured neck of femur is associated with instances of perioperative death or severe harm steady with BCIS.
“There is a need to have for stronger proof that weighs the hazards and advantages of cement in hip hemiarthroplasty for fractured neck of femur.”
“What if you by no means had to fret about meals once more?” asks the internet site for considerably-buzzed about food substitute Soylent. For a slew of factors, from environmentalism to individual well being and “having much more freedom with [your] time and money”, the firm needs to change our standard meals – ie ones produced of food – with a “default meal” that is “cheap, healthier, handy and ubiquitous.” Their vision for the potential of foods? A drinkable, beige macronutrient goop.
But the crowdfunding-backed anti-foods startup is not the 1st to inquire whether we’re performing this consuming factor all wrong. As Soylent will get ready to make its very first official delivery to 20,000+ curious clients this month, we get a seem at other notable attempts to replace, redesign, or radically reimagine what we consume.
Meal-in-a-pill
A meal-in-a-pill stays little much more than a caricature of ‘the future’ to this day
Any person who’s observed the Jetsons knows the drill: just pop a single pill and all the satisfaction of a hearty meal can be yours without the hassle of consuming! But the notion that we would 1 day get our sustenance in capsule-form was popularized in mainstream American culture lengthy prior to it was co-opted by science fiction. As Matt Novak writes for BBC’s Paleofuturist site:
In the 1920s and 30s the meal pill showed up in well-liked media as something inevitable, with a touch of the scary. Satire usually experimented with to soften the blow.
In 1926 a newspaper in Utah ran a series of cartoons poking exciting at the notion. In 1, a construction employee on a ledge digs through his pockets to realise that he has left his meal pill at house a grocer plonks 6 turkey dinner meal drugs on to the counter for a lady getting thanksgiving supplies the ladies of the property reflect on the ‘antique’ dirty dishes, a relic thanks to the meal pill.
Of program, the meal-in-a-pill stays small much more than a caricature of “the future” to this day. Packing all our caloric and dietary needs into a tiny capsule turns out to be exceedingly tough – by some estimates, you’d be swallowing much more than half a pound of capsules per day to change breakfast, lunch and dinner.
What’s in it?
Primarily imagination.
Tang and other powdered foods of the Area Age
Tang: an integral element of a contemporary breakfast. Photograph: Vintage Television ad through YouTube
Remember Tang, the astronauts’ drink of option? In the course of the 1960s, the quick OJ-substitute was touted as an integral portion of a contemporary breakfast: it was hassle-free, money conserving and chock-complete of nutritional vitamins. (“A lot more Vitamin C than orange juice” with “no squeezing or unfreezing,” according to an early advertisement.) But although Tang was the most emblematic brand, streamlining food into powdered type was a wider Area Age trend: non-dairy creamer received added to coffee, mashed potatoes came from a box, and sooner or later a entire, instantaneous breakfast match in a glass. Although such products weren’t meant as total foods replacements, they had been replacements for specific foods meant to conserve us time and money – and even support our health.
What’s in Tang?
Mainly sugar. The drink mix is made up of “much less than two% of Orange Juice Solids,” as nicely as many kinds of yellow dyes, maltodextrin (an inexpensive thickening agent which is made from rice, corn, or potato starch, in accordance to FitSugar), artificial sweeteners, and some other things you most likely can not pronounce.
What occurred to it?
By way of the 1990s, the powdered, usually orange-flavored drink mix passed as a reasonable – and fun! – alternative to juice. But it turns out that “naturally and artificially flavored” sugar-powder that simulates orange juice is not as excellent for you as juice from a actual orange. Go figure.
You can still get Tang in a lot of supermarkets across the US, but income have plummeted given that its heyday as a staple of the American breakfast table. Tang has discovered a new fanbase in emerging markets like Mexico and the Philippines, even so – and parent business Kraft Foods released a new flavor just final week: orange-pineapple.
Liquid nutrition dietary supplements
A screengrab from the Ensure internet site.
You can locate “liquid nutrition dietary supplements” like Make sure or Increase on grocery retailer and pharmacy shelves across the nation. These “shakes” come in a variety of flavors and can be can be consumed in addition to a typical diet, as replacement for one particular or two meals a day, or in lieu of foods altogether. They have been created largely for use with medical supervision by the elderly, sufferers recovering from illness, and other people who need support putting on or retaining excess weight, but have recently been marketed for use by healthier grownups. “Cool, creamy Ensure is fantastic for an occasional breakfast or lunch, or a delicious in between-meal snack,” the internet site tells us – although such well being claims have been challenged.
What’s in it?
Make certain Full is water mixed with sugar (about 5 sugar cubes-worth per bottle), maltodexterin, “milk protein concentrate,” “soy protein isolate,” and many other elements, like nutritional vitamins, minerals, sweeteners and food dyes. You can see the total nutrition label here.
What’s its story?
In a most grim example, Make sure has been used by way of nasal intubation to force-feed hunger-striking prisoners at Guantánamo Bay, but that is far from a regular use situation. Make sure, Increase and equivalent goods are accessible at local pharmacies and grocery shops for anyone who cares to consider them, but consulting a doctor prior to making any main dietary adjustments is recommended.
Soylent
Globe hunger is a logistics issue.
Soylent helps make some daring claims about life efficiency on its website. Consuming powdered macronutrient mix alternatively of eating foods saves you “the time and money invested purchasing, cooking and cleansing, puts you in superb health and vastly lowers your environmental influence by getting rid of a lot of the waste and harm coming from agriculture, livestock, and foods-connected trash,” according to the business. That health claim has been generally rebuked by nutritionists and doctors, who note that a “balanced diet” means much more than just a record of nutrients and vitamins – but, let’s not dwell on that also a lot right here, other individuals have covered it. Even though Soylent is but to ship its very first batch to an eagerly awaiting public, the help they have acquired so far exhibits there is a bigger industry for meals options than some of us might have considered.
What’s in it?
The main ingredient is maltodextrin, the thickening agent talked about earlier. The Soylent mix also is made up of canola and olive oil, sucralose (the kind of sweetener located in Splenda), “artificial flavor” and a really lengthy checklist of vitamin dietary supplements. Soylent has posted their nutrition label right here. *Is made up of no folks.
What’s in its long term?
Soylent raised far more than $ 1m by way of Crowdhoster and received an extra $ one.5m in venture capital from Silicon Valley backers. In all, the organization says it has offered above $ 2m well worth of their meal-substitute mix ahead of the 1st shipment, which is scheduled to go out at the finish of this month. We’ll have to wait and see how many people can sustain the no-food diet regime, but preliminary testimonials are not so encouraging.
