Hospital Dr News

College condemns obesity surgery dispute

The Royal College of Surgeons has condemned the dispute between local and national commissioners over surgery for the morbidly obese.

Access to bariatric surgery is being denied, says the college, because intensive weight loss programmes, which are a prerequisite to surgery, are not being commissioned in some areas.

CCGs and councils are in conflict with NHS England, leading to confusion which has hampered the treatment of patients needing procedures like stomach stapling or gastric band fitting.

The national service criteria set by NHS England for the treatment state that a patient must have received “tier 3” intensive weight management support in advance.

Based on NICE guidance, it recommends individuals have tried and exhausted all non-invasive treatment options prior to potentially higher-risk surgical approaches. As part of this, it requires patients to complete support from weight management services which helps them to succeed in controlling their diet post-surgery.

These non-surgical measures can include psychological assessments to ensure patients are doing everything possible to lose weight before resorting to surgery. Although CCGs commission some of these services, in some areas this role is performed by councils, following the transfer of responsibility for public health to local authorities.

Some CCGs and local authorities target their support at people who have not yet reached the highest levels of obesity and therefore do not commission tier 3 services.

From April, NHS England will not pay providers for work that does not meet the new specification.

Recent Hospital Episodes Statistics data shows there has been a fall of 10% in the number of bariatric surgical procedures being performed between April 2012 and March 2013, even though the most recently available statistics show obesity rates in England continue to rise.

The RCS is concerned that the current problems with commissioning weight management has led to a further fall in the number of bariatric procedures, as these programmes are a prerequisite for referral to bariatric surgery.

Professor Norman Williams, president of the Royal College of Surgeons, said: “To hear that a postcode lottery is emerging in UK weight management provision is deeply worrying. The fact that access to surgery is blocked because of this means the NHS is simply storing up problems for later and compromising patient care.”

The British Obesity and Metabolic Surgery Society, in conjunction with the college and other partners, has produced NICE accredited commissioning guidance for weight assessment and management programmes.

The guidance is intended to assist CCGs in commissioning these services and reduce variation in access to these clinics across the country. This guidance is due for publication early this year.

Richard Welbourn, president of the British Obesity and Metabolic Surgery Society, said: “The benefits of bariatric surgery are well-known. It leads to greater body weight loss and higher remission rates of type 2 diabetes than non-surgical treatment of obesity.

“Poor access to bariatric surgery therefore places some patients at continuing health risk. In the long run this will end up costing the NHS more.”

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