Lothian Doctors defend treatment ban for smokers

Dr David Farquharson, medical director at NHS Lothian, denies there is a blanket ban on smokers. Picture: TSPL
Dr David Farquharson, medical director at NHS Lothian, denies there is a blanket ban on smokers. Picture: TSPL
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Scotland’s second largest health board has defended the practice of asking smokers to quit before they access certain treatments.

Vascular surgeons at Edinburgh Royal Infirmary (ERI) said they would not take GP referrals for non-emergency patients unless they had stopped smoking.

Doctors and NHS Lothian argued that medical intervention could be avoided if people simply stopped smoking and changed their lifestyles, adding that smokers could face extra complications in surgery.

They said there was no blanket ban on smokers having certain treatments.

But the move was criticised by patient groups.

The NHS can limit access to a number of treatments due to factors such as smoking and obesity – for example IVF which can be less successful in patients who smoke.

Vascular surgeons specialise in treating diseases affecting the arteries and veins.

Risk factors for vascular disease include smoking, diabetes, high cholesterol and high blood pressure.

Surgeons at the vascular surgery service at the ERI said they were refusing GP referrals from patients who failed to stop smoking.

Consultant vascular surgeon Zahid Raza said that patients who did not present as a medical emergency would not be seen unless they made lifestyle changes.

“In Edinburgh, we will not see patients at the clinic that are still smoking. Evidence shows that they would not do well with the treatment,” he said.

“In the case of people that have pain when they are walking, then changing their lifestyle, stopping smoking, getting their diabetes or high blood pressure under control, an exercise programme and seeing a physiotherapist would see changes in their condition.

“We have refused to take GP referrals from patients that are still smoking. Some patients have written to their MP demanding to see a consultant. I have written back to the MP to explain our position.”

Mr Raza added: “We try to avoid intervention and, in around 80 per cent of cases, a smoker’s condition will improve just simply by stopping smoking and making other lifestyle changes.”

However, Dr Jean Turner, from the Scotland Patients Association, said she was “extremely disappointed” by the stance.

“I’m really quite shocked. You should not refuse to see anybody and certainly not penalise patients who are smoking,” she said.

“Smoking is an addiction and if someone is in agony with their legs then that could lead to other health problems, such as depression.

“It is very God-like and highly unfair to refuse to see people referred from general practitioners and if I was a GP I would be very angry. It’s not for a doctor to make a judgment. Doctors are there to see if they can help and relieve symptoms.”

Dr David Farquharson, medical director at NHS Lothian, said: “NHS Lothian treats every patient on an individual case-by-case basis and there is no blanket policy in place that rules that smokers cannot undergo 
procedures or access certain areas of healthcare.

“In serious cases, medical intervention and procedures will always be provided swiftly, but we also recognise that some kinds of surgical operation are less likely to be successful in patients who smoke and that complications of surgery are more common in patients who continue to do so.

“The best option can actually be to refer a patient into smoking cessation, fitness and diet intervention programmes to help them change their lifestyle, which will in turn improve their condition and if necessary the outcome of any medical intervention.”

A Scottish Government health spokeswoman said: “Smoking is never good for you.

“Patients who continue to smoke need to think very carefully about the increased risks involved, if surgery is being considered as a treatment option.

“However, a blanket ban on surgery for smokers is not acceptable and is not something that either the Scottish Government or NHS Lothian have 
proposed. ”