The UK’s National Health Service (NHS) will ban patients from surgery indefinitely unless they lose weight or quit smoking, under controversial plans drawn up in Hertfordshire. The Daily Telegraph reports that the restrictions – thought to be the most extreme yet to be introduced by health services – immediately came under attack from the Royal College of Surgeons. Its vice president called for an “urgent rethink” of policies which he said were “discriminatory” and went against the fundamental principles of the NHS.
The report says in recent years, a number of areas have introduced delays for such patients – with some told operations will be put back for months, during which time they are expected to try to lose weight or stop smoking. But the new rules, drawn up by clinical commissioning groups (CCGs) in Hertfordshire, say that obese patients “will not get non-urgent surgery until they reduce their weight” at all, unless the circumstances are exceptional.
The criteria also mean smokers will only be referred for operations if they have stopped smoking for at least eight weeks, with such patients breathalysed before referral. East and North Hertfordshire CCG and Herts Valleys said the plans aimed to encourage people “to take more responsibility for their own health and wellbeing, wherever possible, freeing up limited NHS resources for priority treatment”. The report says both are in financial difficulty, and between them seeking to save £68m during this financial year.
Ian Eardley, senior vice president of the Royal College of Surgeons, said it was wrong to bar NHS treatment to any group of patients. “Singling out patients in this way goes against the principles of the NHS,” he said. "This goes against clinical guidance and leaves patients waiting long periods of time in pain and discomfort. It can even lead to worse outcomes following surgery in some cases,” he said. "There is simply no justification for these policies, and we urge all clinical commissioning groups (CCGs) to urgently reverse these discriminatory measures."
The report says the senior surgeon said he was concerned that the latest rules were the “tip of the iceberg”. And he raised concern about the fact such policies meant patients were refused a referral without even seeing the specialist who should take such decisions.
West Hertfordshire Hospitals Trust medical director Michael van der Watt, wrote to the CCGs warning of “significant opposition” to the proposals at the trust. He said: “There is a wealth of evidence that does not support the theory that worst outcomes occur in patients with a BMI greater than 30”. St Albans City and District Council’s health and wellbeing partnership said the restrictions would set a “dangerous precedent”.
The plans, which will also see cuts in IVF provision and provision of medicines, also provoked anger from the Local Pharmaceutical Committee, who said: “Those who can afford services will buy them and those who cannot will go without.”
The CCGs said: “This policy is designed to improve patient safety and outcomes, both during and immediately after non-urgent surgery. No financial savings are expected as a result of these measures. We do however hope to improve the long-term health of our residents through the targeted stop-smoking and weight-loss support on offer to patients.”
Joyce Robins, from Patient Concern, is quoted in the report as saying: “This is absolutely disgraceful – we all pay our taxes, and the NHS should be there when we need it; we did not agree to a two-tier system.” The CCGs already delay surgery for up to nine months for those with a high BMI, telling them to lose at least 10% of their weight.
The report says the new rules increase the amount of weight the heaviest patients must lose – and crucially, they mean those who fail to lose weight or give up smoking could wait indefinitely. The restrictions mean those with a Body Mass Index of 30 or more will be set targets to reduce their weight by 10% over nine months, with those with a BMI over 40 will be told to cut their weight by 15%.
At the end of the nine months, any patient who failed to lose enough weight will have their circumstances “considered by a clinical panel” a spokesperson said. Those who have not lost enough weight could be left waiting indefinitely, she confirmed.
The CCGs said: “In exceptional circumstances, clinicians will allow surgery to go ahead even if the smoking and weight loss criteria are not met. Exceptions would be made when waiting for surgery would be more harmful for the patient.”
Around 15% of their population smoke, while 22% of adults are obese, the report estimates.
According to the report, in a consultation on the changes, the health bodies said they faced a £550m health and social care funding gap by 2021 unless they took action.
In a forward to the consultation outcomes paper, the CCGs’ CEOs said the region faced a £550m health and social care funding gap by 2021 unless they took action. The CCGs said the decisions had not been taken lightly, and that there had been public backing for most of the changes, during a public consultation.
[link url="http://www.telegraph.co.uk/news/2017/10/17/nhs-provokes-fury-indefinite-surgery-ban-smokers-obese/"]The Daily Telegraph report[/link]