Commissioning

NHS England authorises controversial CCG plans to delay surgery for obese patients

Vale of York CCG’s controversial proposals to ask obese people and smokers to lose weight and cease smoking or face delays to routine surgical procedures have been approved by NHS England.

Patients with a BMI of over 30 will be asked to lose weight or face a year’s delay for elective surgery while smokers will be asked to quit smoking for two months or see their elective surgery postponed for six months, the CCG confirmed.

The CCG, which covers the city of York and several rural market towns, offered assurance that the proposals would not be a ‘blanket’ policy when they come into force next January, but said that each patient would be dealt with on a case-by-case basis.

The CCG added: “Smokers and obese patients that need routine surgery, but do not wish to access the support services or fail to meet the criteria will not be denied their operation, but it could mean they have to wait longer than they otherwise would have done.”

Dr Shaun O’Connell, the clinical lead at Vale of York CCG, defended the plans, saying they would give patients the “best possible health outcomes in the long term” while protecting the CCG’s finances.

The CCG confirmed there will be situations where the plans to postpone surgery will not apply, likely to include emergency and bariatric surgery and operations on patients under 18.

This past summer, NHS England asked the CCG to review its draft approach after the Royal College of Surgeons raised concerns that the proposals went against clinical guidance and targeted smokers and overweight patients in order to save money.

An NHS England spokeswoman said: “Vale of York CCG has made clear its commitment to supporting patients to achieve better health and clinical outcomes by referring them to an established weight loss or stopping smoking programme, where appropriate.

“However, every patient’s case will be considered in the light of their own particular circumstances and on the basis of clinical need.”

Research by the Royal College of Surgeons found that one third of CCGs have at least one mandatory threshold for surgery based on BMI or smoking status.

Clare Marx, president of the RCS, said that it is ‘absolutely right’ that the NHS looks at how best to support obese patients and smokers, but believed that such draconian measures show CCGs taking the wrong approach in what could become a “rationing of NHS treatment … at a national level”.

“Attempting to ration services by simply banning these groups from having vital surgery for up to a year is the wrong approach and frankly shocking. Decisions about whether to treat a patient should be based on their need, and not arbitrary criteria about weight and smoking status,” added Marx.

“This decision comes just a few days after there was no extra funding announced for health and social care in the Autumn Statement. The NHS funding crisis is not an abstract issue; it is affecting patients’ fundamental right to treatment. If smokers and obese patients are hit this time, where will the rationing decisions fall next?”

The government responded by restating the CCG’s reassurance that patients who do not meet the necessary criteria will not be denied their operation, saying that it is right that clinicians give the appropriate advice to patients before proceeding with surgery.

“Procedures for patients will be based on the best interests of the patient’s health. They won’t be denied the operation. What is important is that the patients receive the appropriate clinical advice and that is what is taking place at the Vale of York CCG,” a Downing Street spokesperson noted

“It’s consultants and clinicians whose job it is to give that advice, and it’s for them to advise what is in the best interests of their patients before they undergo surgery.”

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