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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.