The UK Bariatric Surgery Registry is one of the outstanding achievements of past BOMSS Council members. It contains data on over 60,000 patients and has clearly demonstrated that modern weight loss operations are highly effective and safe, with the potential to save the health service money by reducing the burden of diseases associated with obesity. So why is the annual volume of NHS-commissioned bariatric surgery – at under 6,000 operations a year – 5- 10 times less than most European countries?
One answer was the disastrous effect of year on year reductions in payments made to Trusts undertaking bariatric surgery, to the point where it became financially unviable. With no incentive to continue or establish a loss-making service we were at risk of entering a vicious cycle of reduced surgical capacity dictating the ability of the NHS to deliver bariatric services.
Over the past 3 years BOMSS has been working behind the scenes with a variety of high-level NHS organisations to put the case for better, more clinically logical coding and thus fair remuneration for the surgery we perform. The current 2019/20 tariff reflects the results of these labours and finally puts bariatric surgery on a more reasonable financial footing.
This gives the potential for growth in our specialty and now that Trusts can afford to develop or expand Tier 4 services, one of the core aims of the current BOMSS Council is an ambitious target to move towards 20,000 NHS-commissioned bariatric procedures pa over the next 5 years. This target is a drop in the ocean of unmet need in the UK, but it will still take an enormous amount of effort on the part of all BOMSS members to take every opportunity to continue with efforts to educate and cajole government, commissioners, colleagues, primary care and the public about the transformative benefits bariatric surgery has on patients’ lives and their health.
Obesity might well have roots in unhappiness, psychological trauma, poverty, poor education or even just plain hedonism, but these triggers cause a catastrophic failure of the physiology that regulates the body’s normal energy intake. Surgery re-boots this natural control system, giving patients the chance of a better life. Severe obesity is a disease state – we need to start treating it as such and getting that message through to anyone who will listen.
Whilst this is all well and good, I think it’s important not to lose sight of the fact that BOMSS is our society and as well as looking after our patients’ interests, we should not forget to look after each other. This will be a major theme of the 2 years I have the privilege of being BOMSS President.
Plans are already in development to create several platforms for peer-to-peer support, where members can either publicly, or privately seek help and advice from colleagues, get external support and representation when dealing with your Trust and receive support if they fall into the invidious position of potentially having medical indemnity for private work withdrawn. We want to help our members avoid the stress of medico-legal action by standardising the consent process, providing detailed procedure-specific printed consent forms and offers of preceptorship for those st an early stage in their bariatric career. We need to do more to make membership of BOMSS something of value.
The multispecialty makeup of BOMSS Council has always been inclusive (we are the envy of most other surgical societies in this regard) but we want to extend that inclusivity by working more closely with international societies who share our aims and with other parallel specialties who make up the bariatric MDT. With less and less industry sponsorship for meetings (and less study leave), collaboration is going to be key going forwards. And on the subject of closer collaboration, it’s probably time we took a fresh look at our future relationship with our ‘parent’ society AUGIS. The kids have grown up and we need to have chat with Mum and Dad.