CCGs rationing access to bariatric surgery is counter-productive
It is well-known that people who are seriously obese will develop other medical conditions as a result. This often compounds the obesity and takes a toll on their general health, and the healthcare economy. It’s also been established that for some, surgery can help them lose significant weight and return to a healthier lifestyle. It is proven to be safe, effective and saves the NHS money in the long term.
So it is clear that bariatric surgery should be made more readily available to those who need it when everything else has been tried.
Unfortunately it’s not proving to be that simple. As a recent survey carried out by BOMSS in collaboration with the Royal College of Surgeons reveals, some clinical commissioning groups (CCGs) have taken it upon themselves to make it harder for patients to be considered eligible for surgery, in defiance of official national guidelines issued by NHS England and the National Institute of Health and Care Excellence (NICE).
Some of these CCGs say patients must have a body mass index of at least 50 before they will be considered – NHS England and NICE say the threshold should be 40, or 35 if they have other comorbidities, such as diabetes. A couple have demanded that patients must be non-smokers or must sign up to smoking cessation policies before they will be considered.
However, there is a danger that devolved decision-making will be used to make savings by denying treatment to people who need it. Other specialties such as knee and hip replacement surgery have already faced this divisive and irrational trend among some CCGs – now, it seems, bariatric surgery is being targeted. An unfair decision against a section of society already shown to suffer prejudice.
This would be a backward step. Treatment must be available to all based on clinical need. If these CCGs are allowed to flout national guidelines there will be many people who will be denied much-needed surgery and forced to continue living with a debilitating condition – purely because of where they happen to live.
It is also likely to prove counter-productive. As Clare Marx, President of the Royal College of Surgeons points out, raising the threshold people must reach before they will be considered for bariatric surgery sends out a worrying message to people suffering serious weight and obesity problems: you must get even more over-weight before you will be considered for treatment.
The 2018 BOMSS ASM will be in Telford Conference centre (Shropshire) 24-26 January, 2018. We will construct a programme that offers a slightly different take on the norm, perhaps focusing on commissioning, team structure and practice-based issues that we all face day to day.
This is a time of great anxiety for the NHS. Those services that are vulnerable to the vagaries of political and public opinion face an uncertain future. Bariatric surgery – and the wider management of metabolic problems associated with obesity – will be in the firing line as services square up to be accepted. Despite all the evidence we have in support of developing and expanding what we do, we still find prejudice, while ignorance amongst colleagues and health service managers is one of our most challenging barriers.
The NBSR is our key to all debates regarding the future. Our data is amongst the best healthcare outcome data there is. Our actual outcomes are world class. The NBSR deserves our continuing promotion and support from NHS Trusts. I would urge those of you that undertake private bariatric work to ask your private hospitals to source their private activity and outcome data from NBSR.
I believe the society now needs to engage outwardly to sell the story that “bariatric surgery works” both for patients and the healthcare economy. We may debate (even argue!) about which procedure, when, how etc, but that should be reserved for our meetings and educational sessions. We must provide a united face to patients, the media and the profession that our work is effective. We must resist giving to media or colleagues opinions about which procedure we feel is best (in our hands) or what doesn’t work. This is often quoted back to me as “well, patients regain all their weight” or that “bands don’t work”. The NBSR data says the oposite! Our job is to determine for each procedure how and when they do best, but they all do work. Hopefully, the By-Band-Sleeve study will give some answers to these questions.
Mr Shaw Somers