Access to bariatric surgery is “inconsistent, unethical and completely dependent on geographical location”, surgeons claimed at a conference of UK bariatric surgeons.
A survey of UK bariatric surgeons for the conference revealed that two thirds of surgeons said patients who are eligible under NICE guidelines are refused surgery in their centres.
It also revealed that the criteria for surgery vary dramatically depending on geographical location and within the same Strategic Health Authorities.
Some centres are treating patients with referrals from multiple PCTs with different eligibility criteria. Some patients with a BMI of 60+ are being refused surgery in the same hospital where others with much lower BMIs are being treated. Some PCTs, the survey reveals, are refusing to commission any obesity surgery altogether.
The surgeons are calling for greater consistency and transparency across the NHS so that patients are clear about what they are entitled to and doctors can treat all patients equally.
Mr Peter Sedman, bariatric surgeon and council member of the Association of Laparoscopic Surgeons, said: “There is absolutely no doubt that some patients more needy of surgical treatment than others are 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.”
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 properly assessed for weight loss surgery under guidelines set out by NICE.
One million people in the UK meet the NICE criteria with around 240,000 wanting surgery yet only 4,300 NHS weight-loss operations were carried out last year. Consequently the delay in treating these patients is draining NHS resources, with obesity associated healthcare costs estimated at £7.2billion per annum.
Surgeons claim there is incontestable evidence that surgery is both cost-effective - with surgery costs recouped within three years as obesity associated costs are eliminated - and the only proven successful method of treating the morbidly obese.
Bariatric surgeon and the Royal College of Surgeons’ director of education, Professor Mike Larvin, 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 being denied life-saving and cost effective treatments and effectively encouraged to eat more in order to gain a more risky operation further down the line.”
Surgeons are calling for the Department of Health to invest in a long term strategy to ensure that all patients have equal access to treatment delivered by experienced multidisciplinary teams working out of properly equipped centres that can offer a full specialist assessment, an appropriate treatment and provide safe long-term follow up and emergency re-admission.
Tags: Obesity
