The Royal College of Surgeons say that growing numbers of obese people and smokers are being denied operations as they become “soft targets” for an NHS which has become desperate to save money.
According to evidence, they found that patients were being refused hip and knee replacements and a range of other procedures in more and more parts of England.
They found that 34 per cent of the 200 health commissioners have one or more policies on body mass index (BMI) level or smoking status which prevent overweight patients or smokers being referred for routine surgery.
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The surgeons said that such restrictions were wrong, goes against official guidance and can prolong patient pain and distress.
The Guardian reports:
“Blanket bans that deny or delay patients’ access to surgery are wrong. NHS surgical treatment should be based on clinical guidance and patients should be dealt with on a case-by-case basis,” said Clare Marx, the college’s president.
Some patients with joint problems might need surgery in order to enable them to exercise and lose weight, Marx pointed out.
“While it is difficult to categorically prove such policies are aimed at saving money, it is unlikely to be a coincidence that many financially challenged CCGs [clinical commissioning groups] are restricting access to surgery. Our worry is that smokers and overweight patients are becoming soft targets for NHS savings.”
She said such bans were in breach of guidelines drawn up by the government’s health advisers, the National Institute for Health and Clinical Excellence (Nice).
The college obtained data from 200 of England’s 209 GP-led CCGs, the local NHS bodies that hold budgets and pay for patients’ treatment, and all seven Welsh health boards. It found:
- One in three CCGs (34%) have at least one policy that denies patients access to surgery if they smoke or have a high body mass index.
- More than one in five CCGs (22%) are restricting hip and knee replacements for obese people, up from 13% in 2014.
- Three-quarters of surgeons in a survey in December said they had seen rationing happening in their area, and 89% blamed it on NHS cost-cutting.
- Patients are being told to quit smoking or lose weight before they qualify for surgery, although such changes are hard to make, the college says.
Criteria brought in by Luton CCG, for example, require patients to reduce their BMI to under 30 – the point above which someone is officially classified as obese – and attend weight management classes before they can have any type of surgery.
East and North Hertfordshire CCG operates a similar policy but adds that if a patient cannot get their BMI down to 30 they can have the operation they need if they lose 10% of their body weight.
Tim Wilton, president of the British Orthopaedic Association of specialist surgeons, said: “There is no clinical or value-for-money justification for refusing to fund hip or knee replacements based on BMI or smoker status.
“Good outcomes can be achieved for patients regardless of whether they smoke or are obese, even at BMIs of over 50, and these surgeries are highly cost effective, typically delivering sustained pain relief for a cost that equates to just £7.50 a week.”
Labour said patients were paying the price for the government’s underfunding of the NHS. “It’s utterly unacceptable for people to be waiting in pain and discomfort for an operation because of an arbitrary restriction, which isn’t in the best interest of their own or the nation’s health,” said Heidi Alexander, the shadow health secretary.
“Whilst all of us have a responsibility to look after our own health, I am deeply concerned that these restrictions are the thin end of the wedge. Unless Tory ministers get to grips with the financial crisis in the NHS, even more patients are going to be denied access to treatment.”
Niamh Harris
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