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Some of the United Kingdom’s cash-strapped primary care trusts – regional health authorities funded by the National Health Service (NHS) – have begun imposing restrictions on some medical procedures to curb a massive deficit.

In November, trusts in East Suffolk announced that clinically obese people will be denied knee and hip replacement surgery, even if they are in serious pain. Patients in Ipswich will no longer be considered for joint replacement if they have a body mass index (BMI) of more than 30, the clinical definition of obesity. A person’s BMI is calculated by considering their weight in relation to their height.

We cannot pretend that this [decision] wasn’t stimulated by the pressing financial problems of the NHS in East Suffolk,” Dr. Brian Keeble, the U.K.’s director of public health, told the Guardian newspaper after the announcement.

While local doctors nominally supported the move, stating the dangers associated with operating on overweight people, the motive behind the decision was “unashamedly financial,” Keeble said.

It’s true that many obese patients would not be considered good candidates for joint surgery. They can take longer to recover and are at much higher risk for developing infections and other complications. But the British Medical Association opposes a blanket ban, saying the patient’s personal physician should evaluate cases individually.

The trusts are taking extreme measures to eliminate a CAN$97.3 million deficit by the end of March 2006. The move follows the disclosure in the media that Patricia Hewitt, the British health secretary, will be enforcing a “zero tolerance” policy on NHS deficits to eradicate a forecast deficit of up to CAN$1.4 billion.

Hewitt is placing even more financial pressure on hospitals and primary care trusts, whose boards say it will be impossible to break even without “unacceptable” cuts in service. The trusts were told to save by improving productivity. In many cases, this meant contracting out services such as cleaning and food and entering into partnerships with the private sector. Trusts and hospitals that fail to improve their bottom line face ward closures and staff cuts.

Along with joint replacements, restriction will be placed on surgery for varicose veins, haemorrhoids and hernias. Children with a certain type of chronic ear infection will not receive surgery unless their condition is leading to “educational, behavioural or other problems.”

People can buy private insurance that covers these procedures in which case the hospitals will gladly open their doors. Those without insurance may have to travel to another region and try their luck elsewhere or suffer.

The current financial crisis can be traced to 2000, when Tony Blair’s Labour government launched a 10-year reform program for the NHS, continuing the policies begun under Tory prime ministers Margaret Thatcher and John Major. The NHS stopped funding the regional trusts according to need, instead setting out arbitrary annual budgets and encouraging them to seek out private partnerships to make up the shortfall.

The Blair administration has said it doesn’t matter who provides care, as long as it’s publicly funded. But while the NHS provides the money, private companies are running the show at the expense of patients’ health.

(With notes from The Guardian, Nov. 23, 2005)