It was reported that obesity-related admissions to hospitals has doubled in four years in England. This should be of little surprise as obesity within the general population has been increasing for the last few years – currently 26% of UK adults are classed as obese , despite repeated warnings by doctors of the risks of diabetes, coronary diseases and potentially cancer, as a result of obesity. According to NHS Digital data, in 2016/17 the number of admissions where obesity was a factor increased to 615,000 from 525,000 in 2015/16 – an increase of 18%. As a result, the NHS has seen increasing numbers of patients being treated for a variety of health conditions like type 2 diabetes and coronary diseases.
As a result of increased levels of obesity, the financial pressure on the NHS has increased. Funds which may have previously been spent elsewhere are now required to purchase larger beds and other equipment to accommodate larger patients. NHS chiefs were recently warning that patients can no longer fit into current MRI scanners as a result of the size of patients. One NHS Trust in Wales has recently added a mobile scanner to address this problem. Given the current pressures on budgets in the NHS, would the money spent for the additional scanner not have been spent better had patients been able to fit within the existing scanners? Another consequence of larger patients is that scans are not carried out and other potential health issues may be missed.
MRI Scanners – no longer one size fits all
If patients are unable to fit into existing scanners, then potential health conditions may be missed. If these are not picked up, could there be a potential claim for medical and/or professional negligence? Possibly. Two issues stand out. Firstly, the extent of doctors’ liability if health conditions are not picked up as a result of patients being unable to fit into existing scanners; and secondly, how will NHS trusts manage to find the necessary funds to pay for suitable scanners on already tight budgets. Would a doctor escape liability in the event that a health issue could not be identified because the patient was unable to fit into the scanner? Highly unlikely but the patient’s obesity and resources available may have an influence in any clinical/professional negligence claim. Doctors owe a duty of care to their patients and should take all reasonable steps to diagnose and treat patients. But how can one expect doctors to treat obese patients when the suitable resources are lacking. Consideration also needs to be paid to the fact that the decisions of patients in terms of diet and exercise influences their condition. In the absence of suitable resources, it could be the case that claims for clinic/professional negligence stemming from missed diagnostics could increase in obesity cases.
So how should the NHS approach obesity and the number of obesity-related admissions? The drive to promote healthier diets and exercise is to be commended. But should the NHS also consider restricting gastric band operations to last resort? Certainly there is a case for that argument. At a time of restricted budgets, the NHS cannot afford to cover all gastric band operations, without detriment effect to other areas. It would be unreasonable to expect the NHS to do so for individuals for whom all other options have not been exhausted. Perhaps restricting the number of gastric band surgeries may make people realise that an instant result isn’t always available and that other options may need to be taken.
There is a potential for an increased number of clinical/professional negligence claims against doctors resulting from missed diagnostics as a result of patients being too large for existing scanners. But many of the issues surrounding obesity could and should be resolved outside of NHS trusts – including the continued promotion of healthier eating and regular exercise. This would mean that patients would be able to fit into existing scanners, negating the expenditure on larger scanners and ensuring that potential health issues are identified before litigation becomes necessary.
Co-author Alastair Banks is a Legal Assistant in the medical negligence department.