Smokers and obese people 'soft targets' for NHS savings, say surgeons

Royal College of Surgeons says financially challenged clinical groups are restricting access based on lifestyle factors

Growing numbers of smokers and very overweight people are being denied operations as they become “soft targets” for an NHS desperate to save money, surgeons have said.

Patients are being banned from having a new hip or knee fitted and a range of other procedures in more and more parts of England, according to evidence collected by the Royal College of Surgeons, which said such restrictions were wrong and left those affected in distress.

“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.

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.”

Does this apply to the smokers and over weight doctors and nurses police directors of large companies etc.
When I questioned the method of their obese body mass index at the University hospital against the size and weight of our bone mass structure the nurse replied they have got it wrong and they will be altering it.

Operations have now for a while have been based on a point system on weather you get an operation or even if you are resuscitated or not, even on the basis of not having family especially for after care at home.