Access to NHS weight-loss surgery is ‘inconsistent, unethical and completely dependent on geographical location’, say senior surgeons speaking at a conference of UK bariatric surgeons held today (21st January, 2010) at the Royal College of Surgeons of England.

Constraints on NHS funding mean that in some areas NHS decision makers are opting to ignore professional guidelines and are denying patients’ access to surgery. In others, patients who already meet the criteria are forced to wait until either they become more obese or develop life-threatening illness like diabetes or stroke. Surgeons want to see consistency and transparency across the NHS so that patients are clear about what they are entitled to and doctors can treat all patients equally.

According to the NHS Constitution published in 2009 morbidly obese patients – those with a Body Mass Index (BMI) of 40 or more – have a legal right to be properly assessed for weight loss surgery under guidelines set out by the National Institute for Health and Clinical Excellence. (NICE). However, the College has learned that while some Primary Care Trusts adhere to the guidelines, others are raising the bar so that only the most extremely ill patients – those with a BMI of 50 or 60 with obesity related illness - are being referred for surgery. Surgeons say there is no clinical evidence to support the practice. In fact, evidence suggests that not only do these patients have less to gain from surgery but are far more likely to suffer serious complications.

An anonymous survey of UK bariatric surgeons ahead of the conference reveals that:

• Approximately two thirds of surgeons said patients who are eligible under NICE guidelines are refused surgery in their centres.
• Criteria for surgery varies dramatically depending on geographical location and within the same Strategic Health Authorities.
• Some centres are treating patients with referrals from multiple Primary Care Trusts (PCTs) with different eligibility criteria meaning that patients with a BMI of 60 + are being refused surgery in the same hospitals that are treating patients with a BMI of 40 or less.
• Some Primary Care Trusts are refusing to commission any obesity surgery.

Around one million people meet 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 say 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.

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 multi-disciplinary 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.

Speaking before the meeting, Bariatric surgeon and RCS 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.”

Mr Peter Sedman, Bariatric Surgeon and Council member of the Association of Laparoscopic Surgeons (ALS) 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.”

Mr Alberic Fiennes, President-elect of the British Obesity and Metabolic Surgical Society (BOMSS), said: “We recognise the difficulties faced in dealing with a ‘new’ disease of epidemic proportions but to limit surgery to the most severely obese is unfair and short-sighted and against basic professional ethics. It is also contrary to strategies that are standard for diseases that overwhelm resources.”

Dr David Haslam, Chair of The National Obesity Forum, said: “Bariatric surgery is amongst the most clinically-effective and cost-effective specialities in any field of medicine, preventing premature death, and transforming lives, whilst saving vast amounts of money for the NHS and the economy. Even the most cynical taxpayer should support bariatric surgery, alongside clinicians, in opposing the unethical and immoral barriers to surgery imposed by NHS purse-string holders.”

• Download the bariatric surgery conference programme
  

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Notes to Editors

1. The Royal College of Surgeons of England is committed to enabling surgeons to achieve and maintain the highest standards of surgical practice and patient care. Registered charity number: 212808. For more information please visit www.rcseng.ac.uk.
   
2. The consensus meeting at the Royal College of Surgeons is being held to coincide with the first ever Annual Scientific Meeting of the British Obesity and Metabolic Surgical Society (BOMSS) which will run from 21-22 January, 2010.
   
3. If you have any queries please contact: Matthew Worrall – Email: mworrall@rcseng.ac.uk ; T: 020 7869 6047 Elaine Towell – Email: etowell@rcseng.ac.uk; T: 020 7869 6045 Out-of-hours: 07966 486 832