NHS under fire after announcing obese patients will not get non-urgent surgery until they lose weight

The decision by a pair of NHS clinical commissioning groups to deny non-urgent surgery to obese patients until they lose weight has come under fire from the Royal College of Surgeons.

Patients with a Body Mass Index (BMI) of over 40 will not be referred for routine surgery unless they are able to reduce it to under that number over a nine-month period.

Alternatively they will be required to shed 15 per cent of their weight, according NHS Herts Valley Clinical Commissioning Group (CCG) and NHS East and North Hertfordshire CCG.

Whichever achieves the greater weight loss will then allow them to be considered for surgery.

Patients with a BMI over 30 but under 40 will also be required to reduce that figure to under 30 or lose 10 per cent of their weight before they are considered for surgery.

Both CCG’s will also require smokers to have quit for eight weeks before they are referred for surgery. A breath test will be used to detect the levels of carbon monoxide in their blood.

The decision has prompted the Royal College of Surgeons (RCS) to warn that the new policies go “against clinical guidance”.

It said that it could actually end up costing the NHS more, as patients are forced to wait longer for treatment.

It said that this was just the tip of the iceberg, and that an increasing number of CCGs are using similarly discriminatory policies. Other recent policies had required patients to be in varying degrees of pain, while some CCGs had imposed bans on surgery for several months to save money.

“Singling out patients in this way goes against the principles of the NHS,” said Mr Ian Eardley, senior vice-president at the Royal College of Surgeons. “While it is right that patients are supported to lose weight or stop smoking, this should not be a condition of them receiving surgery.

“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 added: “We are concerned that the policies in Hertfordshire are just the tip of the iceberg. In a report last year, we found that over a third of areas in England had similar policies, and we know that these policies have become much more commonplace since then. What is especially concerning is that not only are more clinical commissioning groups implementing such policies, they are also implementing increasingly harsher policies, restricting patients access to surgery even further.”

“Often we find that these policies are brought in to help alleviate financial pressure,” he said. “The irony is that such policies can actually cost more as patients are simply treated at a later date and may need other healthcare in the interim. Many patients waiting long periods will require pain relief medication and physiotherapy while waiting and their condition may be more complex to treat when they are eventually referred.”

The Independent has contacted both NHS Herts Valley CCG and NHS East and North Hertfordshire CCG, along with NHS England for comment.

A spokesperson from Herts Valleys CCG said: “This policy is designed to improve patient safety and outcomes, both during and immediately after non-urgent surgery. It is not designed to save money.

“Being fit and healthy before surgery can reduce the risk of serious complications, shorten stays in hospital and help patients recover better. We also hope to improve the long-term health of our residents through the targeted stop-smoking and weight-loss support on offer to patients.

“In line with the original policy which has been in place since January 2012, we would expect patients to lose weight over a nine-month period. The policy applies only to non-urgent surgery, and wouldn’t, for example, apply to procedures carried out under local anaesthetic.”

They said that the NHS and Public Health in Hertfordshire fund a Weight Watchers and Slimming World service that GPs can refer patients to at no cost to the patient, and that the CCG is part of the national diabetes prevention programme pilot which provides comprehensive support for people with pre-diabetes.

“If at any time the harm of waiting for surgery outweighs the benefit of losing weight or stopping smoking, the patient will go ahead and have the required surgery. In our experience, most patients go on to achieve the recommended weight loss,” they added.

“The results of our local public consultation indicated very widespread support for this policy.”