Is it ethical NHS patients to be bumped down the queue for surgery if they are unwilling/unable to lose weight or stop smoking?
A recent report from the Royal College of Surgeons shows that around one third of local NHS health bosses in England put restrictions on access to surgery – despite this being against official guidance. However, some of the groups have hit back saying that their policies are actually based on sound evidence, rather than being purely cost-saving measures.
Some Clinical Commissioning Groups (CCGs) have voluntary policies in place to encourage patients to stop smoking or lose weight. However, others have gone a step further by introducing mandatory policies with fixed criteria that patients need to meet before being offered surgery, for example –
- Luton CCG - has a BMI cut-off of 30 for any planned surgical procedure,
- East and North Hertfordshire CCG - requires a patient's BMI to be under 30 or for them to lose 10% of their bodyweight before surgery, and
- North East Essex CCG - requires patients who smoke to stop and attend smoking cessation programmes before referral to surgery.
In defence of its policy, Dr Hari Pathmanathan, chair of East and North Hertfordshire Clinical Commissioning Group, said that without losing weight and stopping smoking, “these patients are much more likely to suffer serious breathing problems, get infections and have heart, kidney and lung complications. It also takes them longer to recover, and they have a higher risk of dying under anaesthetic.”
He also pointed out that each patient’s needs are considered individually and that the restrictions only apply to “planned” surgery.
And this seems key to the argument for such policies – that the individual needs of the patient should come first.
The RCS report suggests that 20% of CCGs has mandatory policies on BMI levels before hip and knee replacement surgery, while 4% have mandatory policies on getting patients to stop smoking before hip and knee replacement surgery.
So perhaps these policies just have the fortunate side-effect of reducing surgery bills?
I’m left a bit confused – if a patient with a BMI over 30 needs surgery in Luton, will they be given surgery they need or not?
There seems to be a distinction being drawn between “planned”, and “necessary” surgery – but surely all surgery performed by the NHS is “necessary”?
If the policy were to deny patients with a high BMI unnecessary surgery – I’m sure we’d all agree.
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