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Obese and smokers see surgery block policy put on hold

Published 03/09/2016

A North Yorkshire authority says patients who exceed a body-mass index of 30 will be denied non-life threatening surgery for up to a year
A North Yorkshire authority says patients who exceed a body-mass index of 30 will be denied non-life threatening surgery for up to a year

A health authority which suggested it would deny non-life threatening surgery to the obese and smokers has said it will put its proposals on hold.

The plans by Vale of York clinical commissioning group (CCG) could have meant that patients who exceed a body-mass index (BMI) of 30 would face delays in receiving some NHS surgery for up to a year.

Leading medics said it could become part of growing trend in hospitals which would see the overweight have elective medical procedures denied as a bid to cut costs.

The restrictions were described as the "most severe" policy the modern NHS has seen by the Royal College of Surgeons (RCS).

But the North Yorkshire authority said it had been asked to review the plans by NHS England.

It said in a statement: "NHS England has today asked us to review the draft approach, which we will now do, and will hold off implementing anything until we have an agreed way forward.

"We will ensure any plans are implemented in line with national guidance, are in the best interests of our patients and are clinically robust."

A spokesman for NHS England said denying operations to a particular group - such as smokers - was "inconsistent" with the NHS constitution.

He said: "Major surgery poses much higher risks for severely overweight patients who smoke. So local GP-led Clinical Commissioning Groups are entirely right to ensure these patients first get support to lose weight and try and stop smoking before their hip or knee operation. Reducing obesity and cutting smoking not only benefits patients, but saves the NHS and taxpayers millions of pounds.

"This does not and cannot mean blanket bans on particular patients such as smokers getting operations, which would be inconsistent with the NHS constitution.

"Vale of York CCG is currently under 'special measures' legal direction, and NHS England is today asking it to review its proposed approach before it takes effect to ensure it is proportionate, clinically reasonable, and consistent with applicable national clinical guidelines."

The report by the CCG said obese patients may secure a referral in less than a year if they shed 10% of their weight.

Similarly, if smokers refuse to quit they faced having procedures delayed for up to six months, which can be accelerated if they quit their habit for eight weeks.

News of the proposed rationing sparked criticism from former health minister Norman Lamb, who said it was "outrageous".

NHS Providers, which represents NHS leaders, said similar proposals were likely to follow in future.

A spokesman said a number of considerations are taken by health services outside of costs when considering the decision to operate, but added: "However, given that we are in the middle of the longest and deepest financial squeeze in the NHS's history, we are likely to see more decisions like this in future."

In April, the RCS found a lmost a third of CCGs have one or more mandatory policies on BMI level, stopping overweight or obese patients being referred for routine surgery.

Cancer patients are not included within the scope of such policies.

Body Mass Index (BMI), which relates to a person's weight and height, is used by experts to define overweight and obese limits.

Those with a BMI of 30 to 35 and above are said to be moderately obese, while someone whose BMI is higher than 40 is classified as severely obese.

The president of the RCS, Clare Marx said: "The policies being introduced by Vale of York CCG are some of the most severe the modern NHS has ever seen.

She added: "We would support any attempts by Vale of York to expand its weight loss and smoking cessation programmes, but introducing blanket bans that delay patients' access to what can be life-changing surgery for up to a year is wrong."

Mr Lamb, a Liberal Democrat who served as minister for state care and support in the Department of Health between 2012 and 2015, said: "Any rationing not based on clinical need is outrageous. But it is caused by the Conservative government persisting with plans to reduce the share of our national income spent on the NHS."

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