UK Edition
Obese patients and smokers banned from routine surgery in 'most severe ever' rationing in the NHS
Obese people will be routinely refused operations across the NHS, health service bosses have warned, after one authority said it would limit procedures on an unprecedented scale.
Hospital leaders in North Yorkshire said that patients with a body mass index (BMI) of 30 or above – as well as smokers – will be barred from most surgery for up to a year amid increasingly desperate measures to plug a funding black hole. The restrictions will apply to standard hip and knee operations.
The decision, described by the Royal College of Surgeons as the “most severe the modern NHS has ever seen”, led to warnings that other trusts will soon be forced to follow suit and rationing will become the norm if the current funding crisis continues.
Chris Hopson, the head of NHS Providers, which represents acute care, ambulance and community services, said: “I think we are going to see more and more decisions like this.
“It’s the only way providers are going to be able to balance their books, and in a way you have to applaud their honesty. You can see why they’re doing this – the service is bursting at the seams.”
The announcement is the latest in a series of setbacks for patients who are facing rolling strikes by junior doctors that threaten to cripple the health service as winter approaches.
The decision by Vale of York Clinical Commissioning Group (CCG) comes amid increasing limits across the NHS on surgery for cataracts as well as hip and knee operations.
Under the latest restrictions, patients in the catchment area who have a BMI of 30 or more will be barred from routine surgery for non-life-threatening conditions for a year, although they may secure a referral sooner if they shed 10 per cent of their weight.
A BMI – weight in kilograms divided by height in metres squared – of 30 is the point at which a person is classed as obese and, on current estimates, more than half the population could be classified as such by 2050.
Smokers who refuse to quit will have planned operations postponed for six months, but may be included on surgeons’ waiting lists earlier by proving they have given up for at least eight weeks.
The ban will not apply to cancer patients, or those with some conditions that could becoming life-threatening, or if exceptional circumstances can be shown.
The restrictions echo others made by health bosses in Hertfordshire, the North West and London in the past two years, where blanket referral bans were imposed on patients on the basis of their weight.
Last month St Helens CCG in Merseyside said it was considering temporarily suspending all non-essential hospital referrals by GPs because of financial concerns.
Reports of rationing have emerged after NHS England admitted in May that its provider sector overspent by £2.45 billion in 2015-16, more than a threefold increase on the previous year.
The figure, which was described as conservative by think-tanks, prompted some hospital chief executives to question the future viability of free universal healthcare.
Mr Hopson called for a “realistic national conversation” about how much should be spent on the health service, and said that if procedures had to be restricted, the reduction should be managed on an NHS-wide basis.
However, Clare Marx, president of the Royal College of Surgeons, condemned the decision to bar obese patients and smokers from routine surgery.
“This policy from Vale of York is among the most severe the modern NHS has ever seen,” she said.
“Leaving patients waiting in pain for treatment longer than is clinically necessary cannot be accepted. In the last month alone, the Royal College of Surgeons has learnt of at least three clinical commissioning groups that are planning to introduce policies that deny or delay patients’ access to surgery as a means to cut spending.
“At this rate we may see brutal service reductions becoming the norm, rather than just being exceptions.”
A statement from Vale of York CCG said: “The local system is under severe pressure. Hospitals are being warned they will not be paid for surgery if they carry out operations on obese patients who are not exempt from the policy.
“This work will help to ensure that we get the very best value from the NHS and not exceed our resources or risk the ability of the NHS being there when people really need it.”
A spokesman for NHS England added: "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."