This site is intended for health professionals only

At the heart of general practice since 1960

pul jul aug2020 cover 80x101px
Read the latest issue online

Independents' Day

Third of areas rationing surgery for obese and smokers, surgeons report

Smokers and obese patients are ‘soft targets’ for NHS savings, with one in three CCGs denying or delaying routine surgery to patients unless they stop smoking or lose weight, a new report from the Royal College of Surgeons has found.

The RCS found that 34% of the 200 CCGs that responded to FOI requests have one or more policies on BMI level or smoking status that stop overweight patients or smokers being referred for routine surgery, in contravention of national guidance.

More than a fifth of CCGs are placing weight thresholds on referral to hip and knee replacement surgery – an increase from 2014 when data showed that only 13% of CCGs employed such policies.

Some CCGs said they require a patient’s BMI to be under 30, with mandatory referral to weight management services before any planned surgical procedure – a policy the RCS highlighted as ‘worrying’.

The RCS said that health ministers should make it clear that it was ‘unacceptable’ for the NHS to ban or delay treatment on the basis of a patient’s weight or smoking status, unless this was backed up by evidence from NICE.

Dr Clare Marx, RCS president, said that while public health programmes that assist healthy weight management and quitting smoking were fully supported, blanket bans that deny or delay patients access to surgery were ‘wrong’.

She said: ‘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 may need surgery in order to help them to do exercise and lose weight.

‘While it is difficult to 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.’

A Pulse investigation last year revealed that GPs were facing restrictions on the services they could offer patients as the NHS started rationing care to save money, with hearing aids, IVF treatment and vasectomies found to be the services most widely affected.

Readers' comments (10)

  • Makes NICE a bit pointless (well, they are...but you know what I mean!).

    Either its policy or its not.
    NHS universality anyone?

    Unsuitable or offensive? Report this comment

  • The prime treatment for hip joints labouring under loads for which they were not designed is: lighten the load!
    Lady on Today programme complaining that she had to find out for herself how to lose weight because the surgeon who deferred her cholecystectomy did not tell her (memo to RCS:"Eat less,move more usually works!).With this sort of hapless apathy one doesn't even know where to begin.

    Unsuitable or offensive? Report this comment

  • What about cases where surgical outcomes are worse in these groups (eg. rotator cuff tears in smokers)? Surely it's defensible to prioritise cases where the outcome will be better?

    Unsuitable or offensive? Report this comment

  • I'm not so interested in the clinical argument but the moral one here. If the NHS is free at the point of care, surely this is unconstitutional. If its not free, fine, lets admit that and have the open public debate about what can be afforded, and have it clearly publicised and approved by an elected parliament. Otherwise we are allowing bureaucrats to implement cuts without legal authority in secret.


    Unsuitable or offensive? Report this comment

  • to the Practice Manager 3.29:

    grow up. NHSE can not be open and honest. They are charged with impossible task to manage ever increasing demand with limited funds. Sounds familiar? Something has to give.
    But the man on the radio said there are billions of pounds coming in. So soon, every fatty will have a personal GP and a dietitian doing their shopping and advising local takeaways on how much cheese they could have on their pizza.
    Hope this will be constitutional enough.

    Unsuitable or offensive? Report this comment

  • Alternatively stop smoking and eating your body weight in cakes every day and take some responsibility for yourself.

    GP is crumbling under the weight of large swathes of the public refusing to think for themselves anymore and to buy a few votes the Govt are encouraging this behaviour.
    Why on Earth is it acceptable to think the rest of society and those nasty GPs should be held accountable for what people do day in day out?

    Unsuitable or offensive? Report this comment

  • Harley Thespaniel

    Although they've probably paid for their treatment many times over because of the amount of tax on their fags.

    Unsuitable or offensive? Report this comment

  • Most of the self assessment scoring systems for knee / joint replacement show a better improvement in function for those with a high BMI.

    Unsuitable or offensive? Report this comment

  • Royal College of Surgeons, have you asked what the RC of anaesthetists think or have you forgotten all your medicine about the very real risks of obesity, just joining the government in getting a few headlines?

    Unsuitable or offensive? Report this comment

  • I think it's time to talk sense looking at arguments of both sides.
    Yes, I would consider encouraging an obese person to lose a bit of weight before hip or knee surgery and would stress on the futility of doing anything if the persons joint crumbles under the increasing body mass post surgery.
    Evidence or no evidence, the decision should be made by the surgeons jointly with patients. It is unacceptable that a CCG or NHSE put a blanket rule of fixed BMI. You do have groups of people, for example those with metabolic syndrome or PCO who will struggle to lose weight. What becomes of them?

    Unsuitable or offensive? Report this comment

Have your say