Supersized Purchasing

Wherever you come in the NHS supply chain,  if you haven’t already had to supersize your hospital or community equipment for patients over 25 stone, you are either lucky or negligent. In a poll published last year the Royal College of Surgeons failed to identify a single South West England hospital accepting acute surgical admissions as having bought all the recommended equipment. Even when upgraded handling equipment had been acquired, nursing staff were not necessarily aware of its existence [Ann R Coll Surg Engl (suppl) 2012: 94: 338-41]. The poll’s conclusion was that National Patient Safety Agency and Health and Safety Executive advice, published in 2007 & 2010 respectively, had not be put together for fun and should no longer be ignored. Failure to address this situation could mean, as US lawyers will testify, costly clinical and medicolegal consequences.  
So read on, cheerfully, and face the fact that the sometimes dramatic additional costs are not something that you can’t afford but should be regarded as investments in the future. Obesity is a cradle to the grave disease – whether it be with very overweight pregnant women requiring extra long needles for epidurals at childbirth or XXXL freezers in the mortuary – and, believe me, will be around for a long time.

The day-to-day impact
Bigger freezers are only the half of it. Though overall levels of obesity are allegedly declining,  the fatter are continuing to get even fatter. This means that pretty much everything you work with on a daily basis should be considered for upsizing: larger examination couches, scales, commodes, beds, mattresses, wheelchairs and hoists – you name it – will have to exist side‑by-side with your standard equipment when outsize patients are delivered to your door. The onus will still be on you to ensure that you can care for them with dignity and your colleagues can do so without fear of personal injury.   

It’s not just the big stuff, either. Along with the epidural needles, standard surgical instruments including scissors, graspers and needle holders are no longer long enough for keyhole surgery on some obese patients.    
If delivering these patients to your door is not your headache, it will be one for somebody. Though the corridors, landings and general wards in your premises may already be big enough to accommodate wider beds and assorted paraphernalia, chances are somewhere along the way doors may have to be refitted, lifts strengthened and additional ramps constructed to allow beds to be manoeuvred safely.

The impact on ambulances
Then there are the ambulances. Ah, yes! At up to £90,000 a throw, these beasts, with reinforced chassis and double-width trolleys strong enough to take patients weighing up to 70 stone, are now familiar vehicles in the regional services. Since it would be inappropriate to allocate such expensive vehicles simply to ferry overweight patients to and from their homes around and about, reinforced mini-buses have also had to be purchased for day-to-day transport. So the NHS bill goes up.
But it’s not over yet. The cost of a fire crew to prize people from their houses may have to be paid for, too.  Do not believe that a team of rescue specialists called in to assist paramedics in the transfer of a 63s stone lady from her first floor bedroom to an ambulance may have no charge attached to it.  In this infamous case in South Wales it took the team the best part of a day to do the job at an estimated £100,000 cost. Graciously fire chiefs tend not to make more than a token charge for such work but don’t bet on this state of affairs continuing.

Ask the zookeeper
The NHS might have to pay zoos invoices, for instance.  Though no UK zoos have admitted to hiring their animal scanners to hospitals whose own CT and MRI units can’t accommodate the very obese, they have certainly been asked to. The Royal College of Surgeons of England warns against such a situation occurring here, but points to US where zoos have been so utilised.  However degrading this might be, one obesity specialist has been quoted as stating “you can’t die of shame – but not having a scan when you require one might kill you!”

The final resting place
So death, finally, has to be reckoned with.  Not just because of the mortuary fridges but because of crematoria capable of accommodating cadavers up to 50 stone and coffins that need to be 40 inches in width.  The local authority in Burnley also instructed funeral directors to cremate fat people before 9.30am because their ashes clog up crematorium burners and, in extreme cases, JCBs have also had to be called in to for coffins, at three times their standard size, to be lowered gently into their final resting place.   

Mind you, the NHS and society in general shouldn’t quibble about the cost.  We have brought all this on ourselves following years of unbelievable negligence by politicians and the Department of Health [DH].  

Obesity was flagged up as a mainstream “issue“ over a generation ago in the report, the Health of the Nation, but official inertia guaranteed that the issue didn’t go away. The 1991 prediction was that, by 2000, the proportion of obese adults should be seven per cent or less – spirited away by a few leaflets urging behaviour change and a healthy lifestyle. The actual figure was double that figure and to-day, 13 years later, a 350 per cent increase in the obesity statistics stands testimony to Westminster’s continued inaction. At the moment the inaction is costing the country some £5.2 billion a year so a few thousand quid here and there for supersize equipment is cheap at the price.    
Some enlightened action was once proposed but quickly shelved. The idea was that three-yearly checks on adult height and weight would be helpful in routinely spotting, and dealing with, individuals who were piling on the pounds. It was deemed questionable however to task GPs with widespread measurement of body mass index [BMI] so a compromise was reached. Quality Outcome Frameworks [QOF] payments would be paid to GPs for “establishing and maintaining a  register of patients age 16 or over with a BMI ≤30 in the preceding 12 months,“ but no QOF money was earmarked for GPs to do anything useful with the data! The consequence is that GPs continue to pick up a tidy sum for compiling lists of their fattest patients but the patients themselves receive little benefit.

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