Patients requiring life-saving weight loss surgery are being refused treatment because of “inconsistent and unethical” hospital policies, leading surgeons warn today.
Funding constraints mean patients are denied gastric band operations despite meeting NHS guidelines — with some in effect encouraged to eat more to help prioritise their cause.
The bariatric surgeons warn that some patients are forced to wait not until they become more obese, but also until they develop life-threatening illness such as diabetes or stroke before getting the treatment.
The Royal College of Surgeons (RCS), which is hosting a conference on bariatric surgery today, described gastric band healthcare as “inconsistent, unethical and completely dependent on geographical location”. It wants the Department of Health to invest in a long-term strategy to ensure equal access to treatment.
Two thirds of bariatric surgeons surveyed by the RCS said patients eligible under National Institute of Health and Clinical Excellence guidelines were refused surgery in their centres. They also reported wide variations, even within the same health authority, with some refusing patients with a body mass index of 60-plus while treating patients with a BMI of 40 or less. Others were said to be refusing to commission any obesity surgery.
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Mike Larvin, a bariatric surgeon and RCS director of education, said: “Nice guidelines are meant to signal the end of postcode lotteries, yet local commissioning groups are choosing not to deliver on obesity surgery.
“In many regions the threshold criteria are being raised to save money in the short term, meaning patients are denied treatments and effectively encouraged to eat more to gain a more risky operation farther down the line.”
According to the NHS Constitution published in 2009, morbidly obese patients — those with a BMI of 40 or more — have a legal right to be assessed for weight loss surgery. However, the surgeons report that some primary care trusts are raising the bar so that only the most extremely ill patients — those with a BMI of 50 or 60 with obesity-related illness — are being referred for surgery. Surgeons say that such cases actually have less to gain from surgery and are far more likely to suffer serious complications.
The delay in treating these patients is draining NHS resources, with obesity-associated healthcare costs estimated at £7.2 billion a year.
Surgeons say that surgery costs are recouped within three years as obesity-associated costs are eliminated, and it is the only successful method of treating the morbidly obese.
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Peter Sedman, bariatric surgeon and council member of the Association of Laparoscopic Surgeons, said there was “absolutely no doubt” that some patients more needy of surgical treatment than others were being denied it. “I will treat the patient, my hospital will offer the service, but unless the patient moves house they will not be referred and if they are, the treatment is subsequently blocked.”
Mr Alberic Fiennes, president-elect of the British Obesity and Metabolic Surgical Society, added: “We recognise the difficulties in dealing with a ‘new’ disease of epidemic proportions but to limit surgery to the most severely obese is unfair and short-sighted and against basic professional ethics.”
David Haslam of the National Obesity Forum, said: “Bariatric surgery is amongst the most clinically-effective and cost-effective specialities in any field of medicine, preventing premature death and transforming lives, while saving vast amounts of money for the NHS.”