Plans to deny surgery to obese patients and smokers put on hold

A health authority that 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 have warned that it could become part of a growing trend in hospitals that could result in overweight patients being denied elective medical procedures in 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.

“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 the 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 almost 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, 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.

“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.”

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.”

Plans to deny surgery to obese patients and smokers put on hold

NHS "defies the law" to deny pensioners important operations, warns Royal School of Surgeons

It exposes a main postcode lottery in practice across the country – with a 37-fold variation in costs of surgery for breast cancer for ladies aged 65 and more than, based on in which they live. Hip replacements had been 10 times as common in some elements of the nation as other individuals, with a sixfold variation in prices of surgical treatment for bowel cancer in 2011-12, the figures display.

The RCS president, Prof Norman Williams, mentioned the scale of the distinctions was “extremely worrying,” raising suspicions that some elements of the NHS had been working covert blanket bans against procedures on age grounds.

Final October, the Government launched age discrimination laws which indicate sufferers ought to not be denied procedures on grounds of age. Physicians are supposed to assess sufferers based mostly on their fitness for an operation, and likely benefit from it.

But charities explained they have been concerned that the figures could imply that GPs were “writing off” pensioners, and not referring them to experts, although in other circumstances cost-cutting by NHS authorities was hitting older individuals hardest.

Specialists calculated the fee of surgical treatment per 10,000 folks in England’s 211 overall health authorities, known as clinical commissioning groups (CCGs) during 2011-12. They found that in some regions, amongst individuals aged 65 and above, there were 37 breast excision procedures to eliminate cancerous tumours. In other parts of the nation, complete numbers had been so minimal that they had been calculated as a fee of zero, that means that in total, fewer than five patients obtained the procedure in excess of the 12 months.

Seventeen CCGs had no individuals above the age of 75 receiving the surgery, even though some places had been providing operations for 27 females per 10,000 population.

Equivalent trends have been found in other common procedures.

Fourteen regions supplied no surgical procedure to get rid of gall bladders for these in excess of the age of 75. Twenty-9 places offered “zero surgery” for those aged 75 and over for a single of the six operations analysed.

Some CCGs supplied no surgical procedure to older patients for a range of procedures.

Bradford City supplied no breast excision surgery, gall bladder operations or knee replacement surgical treatment to these 75 and more than in the course of the period.

West Lancashire offered neither breast excision surgery or knee replacements for individuals 75 and more than, even though Corby did not offer any breast excision or gall bladder replacements for individuals of that age. Prof Williams suggested some components of the NHS could be working unofficial “age bans” on certain remedies.

He explained: “These are huge discrepancies – actually large. It is unattainable to demonstrate the motives behind all the variation but we have our suspicions and I fret about age discrimination.

“It is truly worrying when you look at something like colorectal cancer and there is a sixfold difference amongst various components of the nation after the age of 65 — when we know surgical treatment is the greatest type of treatment.”.

The Overall health Secretary mentioned: “We expect the NHS to make confident that all sufferers can access the treatment method they want – discrimination of any type is unacceptable.”

Tom Gentry, Age UK’s policy adviser and one of the report’s authors, mentioned there was no defence for charges of zero surgical treatment for frequent situations amongst the over 75s and that attempts to enhance the scenario needed to tackle a number of barriers, like making certain sufferers came forward with symptoms, and creating positive their medical doctors took them seriously.

He mentioned: “GPs have been recognized to write off symptoms in older age groups, dismissing troubles as aches and pains when in reality they are serious troubles.”

Mr Gentry said sometimes outdated understanding amid medical employees meant they assumed a patient had “had a excellent innings”, when with the right treatment, they could live at least a decade more.

Martin McShane, NHS England’s national clinical director for prolonged term problems, mentioned: “NHS England is committed to making certain older individuals have equal entry to remedy which need to often be primarily based on what is proper for each and every individual patient, on their informed preferences, not their age.”

A spokesman for Bradford City CCG stated all its decisions had been based mostly on clinical need to have and patient choice.

Meanwile, a main report has referred to as for towns and cities to be redesigned to make them match for an ageing population.

Outdoor health club tools for all ages, futuristic “urban pods” to transport individuals close to and even swings at bus stops could also aid folks get out and about more simply and combat loneliness.

The suggestions are contained in a report published jointly by the Global Longevity Centre and Age Uk.

NHS "defies the law" to deny pensioners important operations, warns Royal School of Surgeons