Wednesday, 20 February 2013

NHS ill-prepared to cope with obese patients

NHS ill-prepared to cope with obese patients:  Obese patients often require specialist equipment and more staff, say physiotherapists who warn of impact of obesity on NHS.

Obese patients take up extra bed spaces in hospital, require more staff to treat them and need an array of super-strength equipment to withstand their weight as part of their growing burden on the NHS, physiotherapists have said.
Other patients can miss out on treatment because those who are dangerously overweight need two physiotherapists for their session, while fewer beds have been fitted into some wards because obese patients use bigger ones.
"These patients in general take more than one therapist to treat, require more expensive equipment to treat, and the time trying to locate equipment increases the treatment time," one physiotherapist told a survey conducted by the Chartered Society of Physiotherapy. Very heavy patients also use more NHS resources by staying in hospital for longer, though that can be because of delays in obtaining specialist equipment to help them cope when they get home after discharge, the physiotherapist added.
Another said when obese patients need therapeutic handling after a fall, fracture or stroke "there is an ongoing issue where the only answer currently is more pairs of hands per patient, which means there is less rehabilitation to go round.
"There is only so much of us to go round so requiring a higher ratio of therapist to patient has a knock-on effect to other patients' share of the resource."
Nurses, physios and sonographers, who conduct ultrasound examinations, are suffering injuries as a result of looking after obese patients. The NHS is paying out up to six-figure amounts to settle lawsuits from staff who claim health service managers did not ensure enough staff or extra-strong equipment such as hoists, stretchers and wheelchairs was available to handle and treat the very overweight.
Physiotherapist Marsha Fernihough won £25,000 in damages last year against Warwickshire NHS primary care trust when she ended up unable to work for 17 months and needed two operations after tearing her shoulder when a 20-stone patient fell backwards on to her left arm as she and a colleague were helping him learn to use a walking frame. She has returned to work but can no longer lift heavy items with that arm.
A paramedic sustained a painful back strain when trying to get a man weighing between 25 and 30 stone on a stretcher into position to come out of the back of her ambulance. The injury exacerbated her existing degenerative back condition. She claimed her employers had breached health and safety regulations by not undertaking an assessment of the risk to crews from bariatric patients. They denied liability but later settled for a six-figure sum when she took action through Thompson's solicitors, who act for Unison members.
Many ambulance personnel feel they are not adequately protected against such injuries, despite the growing number of obese patients, one lawyer said. Nurses are also at risk of accidents because they have to regularly turn obese patients to avoid them getting pressure ulcers (bed sores).
"We are hearing too often about nurses having their safety compromised in the course of looking after obese patients. Without the right equipment, enough staff and specialist training, some nurses are injuring themselves by trying to manage on their own," said Dr Peter Carter, chief executive of the Royal College of Nursing, which represents almost all the NHS's 300,000 nurses.
Injury is a particular risk for community nurses who do not have the right equipment or colleagues on hand to help them move very heavy patients, Carter added.
Growing numbers of obese patients prompted University Hospitals Birmingham NHS foundation trust to order super-size facilities such as bed spaces and examination rooms for heavier patients, as well as beds, mattresses and hoists for those weighing at least 160kg at its new Queen Elizabeth hospital, which opened in 2010.
Higher safe working limits mean each ward has a heavy-duty commode for patients weighing up to 318kg, a ceiling track hoist with a weight limit of 450kg and a wide armchair that can hold someone up to 260kg, though three others can withstand 445kg.
Mike Hallissey, the trust's deputy medical director, said obese patients' girth posed as many problems as their weight. While normal MRI scanners can take patients up to 60cm wide, the Queen Elizabeth also has one that can accommodate those 70cm wide. It cost £825,000, some £75,000 more than the usual price. Wide-bore CT scanners also cost more money, as do super-strong operating tables with sides to stop patients rolling off. Patients' concentrations of weight mean they sometimes cannot balance and fall.
"Overweight patients are a much greater burden in terms of mobilisation – that is, you need more nurses or physios to get them up, maybe to get them walking again after an operation. That's a cost pressure that all hospitals have to bear," added Hallissey. In addition, super-large patients need larger doses of radiation when undergoing some types of scan, and the quality of images that result may be poorer, he said.
Obesity costs the NHS £5.1bn a year in treatment and equipment. But the obesity report by the Academy of Medical Royal Colleges this week warned that on current trends, it could become so serious that "the NHS can no longer cope".
Professor Terence Stephenson, the academy's chairman, said: "All doctors are seeing obesity now. GPs see people saying 'I'm overweight, can you help me?'. Surgeons and anaesthetists see it, and there are greater risks in surgery due to obesity. Obstetricians are seeing it in pregnant women, who face extra risks in labour and a higher risk of having an overweight child and diabetes in pregnancy. Psychiatrists see it because it impacts on people's self-esteem. So there's not really a branch of medicine that's not trying to deal with this on a daily basis." The Guardian

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