Surgeons are worried that smokers and people who are overweight are being denied treatment after it emerged that a third of CCGs are putting a ban on surgery for smokers or obese patients.
Surgeons are worried that smokers and people who are overweight are being denied treatment after it emerged that a third of CCGs are putting a ban on surgery for smokers or obese patients.
The research by the Royal College of Surgeons (RCS), Smokers and overweight patients: Soft targets for NHS savings, found that 34% of CCGs had at least one mandatory threshold for surgery, based on patients body mass index (BMI) or smoking habits, and 31% had one or more mandatory policies stopping referrals of overweight or obese patients for routine surgery.
Patients are also required to stop smoking before they can access routine surgery commissioned by 12% of CCGs.
Overall half of the CCGs had at least one mandatory or voluntary policy on BMI, and 24% had a policy about smoking.
Hip and knee replacement surgeries were most likely to be included, with 22% of CCGs insisting on behaviour change before referrals. In 2014 just 13% of CCGs had such policies for hip and knee replacements, said the RCS.
The researchers found that there was no link between the CCGs’ policies and a rise or drop in spending on weight reduction or smoking cessation by local authorities (LA).
The report’s authors said: “We have found that a significant number of CCGs are restricting access to routine surgery for patients who smoke or have a high BMI, in contravention of national clinical guidance.
‘Therefore we recommend that the government reiterates that access to NHS surgical treatment should be based solely on clinical guidance and blanket bans do not best serve patient care.”
They said surgeons and other clinical experts were clear that stopping smoking or losing weight, if necessary, before an operation can improve outcomes of surgery.
However they said decisions about going ahead with surgery should always be between the clinician and the patient.
“Delaying or denying surgery can prolong symptoms for patients, and cause additional stress for patients being required to make difficult lifestyle changes,” the report said.
The RCS called on CCGs to publish the evidence base for their commissioning policies. It also said patients should not be afraid to challenge their CCG if they felt they were denied access to necessary surgery.
Dr Graham Jackson, co-chair of NHS Clinical Commissioners (NHSCC) and chair of NHS Aylesbury Vale CCG said it was wrong to imply the motivation for decisions was purely financial.
He added: “CCGs are working in a challenging context, with a raft of competing demands and often have to take difficult decisions to balance the needs of the individual with the needs of the wider population. There must be a balance between local decision making andnational guidelines and NHSCC continues to engage with NICE and others to make sure that happens.”
