05.09.16
CCG to review ‘draconian’ plans to delay surgery for obese patients
Plans to deny surgery to patients who are obese or smokers in the Vale of York CCG have been put on hold after NHS England asked the commissioners to review the draft approach.
It was revealed last week that the CCG is planning on postponing elective surgery for patients with a BMI of 30 or over for a year or until they achieve 10% weight loss. Similarly, patients who smoke would have surgery postponed for six months or until they stopped smoking for eight weeks.
The CCG initially said that the plans were necessary because of “severe pressure” on its health services.
However, in a statement on Saturday it said: “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.”
Clare Marx, president of the Royal College of Surgeons (RCS), said the policies being introduced by Vale of York CCG are some of the most severe the modern NHS has ever seen.
“Smokers and overweight patients should unquestionably be helped to stop smoking or lose weight prior to surgery for their overall health,” she said. “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.
“In some cases patients needing surgery may find it difficult to lose weight, for example if they have mobility problems. Their condition may also deteriorate if made to wait unnecessarily for surgery.
“As the true scale of financial pressure on NHS trusts has become clear over the summer, we are fast finding ourselves in a situation where CCGs are introducing Draconian commissioning policies, often flouting NICE or other clinical guidance, in order to balance the books. An honest national debate on exactly what the NHS can afford, and what we are willing to pay, is urgently needed.”
In April, RCS research found that one-third of CCGs have at least one mandatory threshold for surgery based on BMI or smoking status.
The latest financial figures from NHS England show that stringent new efficiency measures have helped to cut many trusts' deficits, but led to warnings that more financial trouble could be due in the future.
A spokesperson for NHS England 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,” they added.
“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 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.”
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