In attempts to save costs associated with surgical complications, the NHS is planning to introduce new criteria for obese patients and smokers that are expected to undergo surgery.

It has mandated that smokers need to be breathalysed before undergoing surgery to confirm they have ceased smoking at least eight weeks before surgery. Obese patients, on the other hand “will not get non-urgent surgery until they reduce their weight”. Their body mass index (BMI) must be below 30 or achieve a 10% reduction in body weight within nine months. These restrictions are only liable to change if the patient’s circumstances are deemed “exceptional”.

The initiative has already been implemented by Clinical Commissioning Groups (CCGs) in Hertfordshire, which claim that this move may facilitate improvement of “patient safety and outcomes” as it may be less risky to operate on patients who fit the criteria.

Better health, better recovery rates

Under new NHS criteria, obese patients “will not get non-urgent surgery until they reduce their weight”.
Under new NHS criteria, obese patients “will not get non-urgent surgery until they reduce their weight”.

This is explained on the basis that patients who are in optimal health before surgery are likely to recover more quickly post-operation and therefore, reduce costs associated with bed occupancy and professional care. It may also mean that complications associated with surgery are scaled down, which can reduce subsequent mortality and morbidity.

These changes were implemented on the basis of a public consultation, which revealed that approximately 85% of respondents unanimously agreed that patients should be required to quit smoking before surgery.

The CCGs also claim that individuals will be motivated “to take more responsibility for their own health and wellbeing, wherever possible, freeing up limited NHS resources for priority treatment”. 

However, there is no clinical evidence to suggest that these criteria will help patients transform their lifestyle in the long-term. It also contradicts guidelines published by NICE, which is the clinical governing body for NHS hospitals.

Experts claim criteria “goes against clinical guidance”

“Singling out patients in this way goes against the principles of the NHS. This goes against clinical guidance and leaves patients waiting long periods of time in pain and discomfort,” said Ian Eardley, the Senior Vice President of the Royal College of Surgeons.

Delaying surgery based on the weight of a patient or being a smoker means that patients are likely to undergo suffering for longer periods of time. It also means that the condition in question is likely to progress, which may make it more difficult and complicated to ultimately treat.

Smokers will not be referred for surgery unless they pass breathalyser tests to confirm that they have ceased smoking at least 8 weeks before surgery.
Smokers will not be referred for surgery unless they pass breathalyser tests to confirm that they have ceased smoking at least 8 weeks before surgery.

“There is simply no justification for these policies, and we urge all clinical commissioning groups (CCGs) to urgently reverse these discriminatory measures,” insisted Eardley.

Additionally, there is a pronounced social gradient for both obesity and smoking, making this move particularly insidious. This can be explained through the strengthening link between poverty and childhood obesity over the last decade.

Children living in the poorest areas of the UK are twice as likely to be obese compared to those living in the most affluent. The prevalence of smoking shows a similar association with income and social class. Defining patients based on these criteria would mean that those who are poorest will have the most obstacles to receive proper healthcare.

However, the involved CCGs clearly express that if the surgery is considered to be life-saving and urgent, these requirements may not need to be met.

The new reforms also plan to reduce provision of IVF services and medication. This may also lead to inequity in access of healthcare services, as higher-income groups may be able to resort to private healthcare but lower-income groups may be excluded from purchase of expensive medications. Gluten-free products and female sterilization procedures are also likely to get reduced funding by CCGs in the future. These initiatives have faced criticism because they are perceived to be harsh cost-cutting measures employed by the NHS. It means that some individuals are excluded from surgery on the basis of inappropriate criteria. Some regions have also resorted to pain threshold measures as a marker of whether an individual is suitable to undergo surgery or not. MIMS

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Sources:
https://www.theguardian.com/society/2017/oct/18/doctors-to-breathalyse-smokers-before-allowing-them-nhs-surgery
http://www.breitbart.com/london/2017/10/19/nhs-moves-ban-smokers-surgery/
https://www.theguardian.com/commentisfree/2017/oct/21/observer-view-nhs-funding-smokers-obese-restrictions-rationing-healthcare
https://uk.news.yahoo.com/nhs-bans-obese-smokers-surgery-indefinitely-090639347.html
http://ash.org.uk/information-and-resources/health-inequalities/health-inequalities-resources/smoking-low-income-families/
https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/compendium/
opinionsandlifestylesurvey/2015-03-19/adultsmokinghabitsingreatbritain2013
https://digital.nhs.uk/catalogue/PUB20562