Surgery restricted for smokers and obese patients

According to a report by the Royal College of Surgeons (RCS), patients who are overweight or smoke are often denied treatment until they lose weight or give up smoking, in a bid to save money.

The RCS has called on ministers to make it clear to NHS trusts that discriminating on grounds of weight or smoking status breaches health watchdog guidelines.

The RCS submitted Freedom of Information (FoI) requests to a number of clinical commissioning groups (CCGs). Of the 200 CCGs which replied, 34 per cent claimed they had policies on BMI level and smoking status which stopped smokers and overweight people from being referred for routine surgery.

In particular, a Luton CCG maintained that a patient’s BMI must be under 30 before any elective surgical procedure can be performed. Similarly, East and North Hertfordshire CCG follow the same policy but will allow patients to be referred for surgery if they can manage a weight loss of 10 per cent.

Carl Marx, president of the RCS, said: “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. In some instances a patient might need surgery in order to help them to do exercise and lose weight.

“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 are restricting access to surgery. Our worry is that smokers and overweight patients are becoming soft targets for NHS savings.”

Tim Wilton, president of the British Orthopedic Association, 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.

“Hard-and-fast rules also undermine the NHS’s ability to involve patients in decisions about their own care, and are a distraction from the task at hand: making sure patients receive the best possible advice and care, to enable them to make the best possible decisions for their health – including losing weight and stopping smoking where appropriate.”