Obesity may delay
surgery in new NHS policy    


Dr Ben Janaway  II  NOV 29 2016


In a landmark decision, a Yorkshire clinical commissioning group has agreed that the obese will risk preclusion from non-emergency surgery if they cannot lose weight.  Those who refuse will be refused surgery for up to a year under the new policy. The group stresses that ‘no blanket ban’ will be in place and that cases will be assessed individually. Emergency cases will be continuing as usual.

The decision comes on the back of evidence that obesity is linked with increased surgical risk and cost, but recent contradictory findings have raised concerns of a ‘discriminatory’ contingent to decision making.  Many are concerned that this is the start of an irreversible trend toward ‘health rationing’ in the NHS.

 ‘Exceeding resources is not sustainable in the NHS and risks the ability of services being there when people really need them.” Says Dr. Shaun O’Connell, clinical lead at Yorkshire Vale CCG.

A wealth of historical evidence links obesity (that is defined by a body mass index >30) with major surgical risk. Independent studies have linked being overweight with poorer surgical outcomes, longer hospital stay, anesthetic risk and overall cost. Risk seems to increase when other illness, such as chronic lung disease, is present. However recent research shows that the gap between health related outcomes is narrowing, which may place the emphasis on cost rather than health.

The move, agreed by NHS England, raises concerns over motivation. Earlier plans to reduce health spending on tackling obesity were curtailed this year. It seems that although obesity is a known public health issue, the shift has moved from spending to commission. A greater emphasis is placed on local groups and patients themselves.  This may cause many to ask why the government has reduced spending on something it formally recognizes as of significant health risk.

The move has been criticized for a potential ‘discriminatory’ and ‘cost based’ agenda, rather than purely health orientated.  The decision has raised concerns that NHS England has set a precedent for ‘health rationing’ based on demographic, a concept that must seem extremely attractive for this government after a concerning Autumn budget. However, the pennies saved may mean little to patients.

‘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.’ Says Clare Marks, President of the Royal College of Surgeons ‘If smokers and obese patients are hit this time, where will the rationing decisions fall next?” 

Ove 61% of UK adults are now considered obese, with an increasing trend. Men are more likely to be overweight. Obesity is also heavily linked with a number of dangerous and prohibitively expensive diseases, such as heart disease, stroke, liver disease and several cancers. There is no question that losing weight will save both lives and the NHS vital cash. Although the concept of health rationing may be morally contentious, the reality may be unavoidable within the current economic climate.

As the debate continues, the policy is set to begin in January 2017. If successful, it may be the start of a national policy.


Any opinions above are the author's alone and may not represent those of the NHS or Mind and Medicine. Any comment is based on the best available evidence at the time of writing.  All data is based on externally validated studies unless expressed otherwise. Novel data is representative of sample surveyed. Online recommendation is no substitute for seeing your own doctor and should not be taken as medical advice.

Dr Ben Janaway is a medical doctor and Editor for the online healthcare and education  source ‘Mind and Medicine’.  He writes regularly for patient.co.uk and other national news sources. Contact Dr Janaway at www.twitter.com/drjanaway with stories or for discussion

Sources

Akarsu S (2016) ‘Effect of Body Mass Index on Mortality and Morbidity in Patients Undergoing Coronary Artery Bypass Grafting Surgery’ Heart Surg Forum (Epub ahead of print)
El-Nakeeb A et al (2014) ‘Impact of obesity on surgical outcomes post-pancreaticoduodenectomy: a case-control study.’ Int J Surg 12(5)p488-93
Martin L (2016) ’ When body mass index fails to measure up: perinephric and periumbilical fat as predictors of operative risk’ Am J Surg  (Epub ahead of print)
https://www.noo.org.uk/NOO_about_obesity/adult_obesity/UK_prevalence_and_trends
http://www.dailymail.co.uk/wires/pa/article-3980926/Lose-weight-stop-smoking-face-op-delay-patients-told.html
http://www.minsterfm.com/news/local/2162381/royal-college-of-surgeons-shock-as-obese-face-delays-to-operations-in-york/
http://patient.info/wellbeing/health/obesity-cuts-trimming-costs-not-fat