The Royal College of Surgeons (RCS) has warned that smokers and overweight patients are becoming ‘soft targets’ for NHS savings.
A report from the RCS has found that over one in three Clinical Commissioning Groups (CCGs) in England are denying or delaying routine surgery to patients – such as hip and knee replacements – until they stop smoking or lose weight, in contravention of national clinical guidance.
The RCS report ‘Smokers and overweight patients: soft targets for NHS savings?’ explores how widespread the practice of restricting surgery on the basis of weight or smoking status has become by examining the commissioning policies of CCGs in England. The report compares these against guidance produced by the National Institute for Health and Care Excellence (NICE), RCS and surgical specialty associations (SSAs).
The RCS found that over a third (34%) of the 200 CCGs that responded to FOI requests have one or more policies on BMI level or smoking status which stop overweight patients or smokers being referred for routine surgery. More than a fifth (22%) of CCGs are placing mandatory weight thresholds on referral to hip and knee replacement surgery – an increase on data acquired in 2014 which showed 13% of CCGs employed such policies.
Miss Clare Marx, President of the Royal College of Surgeons, said: “Public health programmes that assist healthy weight management and quitting smoking are fully supported by the College. Affected patients should be encouraged to attend these services while awaiting surgery. However, blanket bans that deny or delay patients’ access to surgery are wrong. NHS surgical treatment should be based on clinical guidance and patients should be dealt with on a case by case basis. In some instances a patient might need surgery in order to help them to do exercise and lose weight.
“While it is difficult to categorically prove such policies are aimed at saving money, it is unlikely to be a coincidence that many financially challenged CCGs are restricting access to surgery. Our worry is that smokers and overweight patients are becoming soft targets for NHS savings. There is no clinical guidance from NICE, the Royal College of Surgeons, and other surgical associations to support mandatory bans for routine surgery on the basis of whether patients smoke or are overweight.”
The RCS said health ministers should make it clear that it is unacceptable for the NHS to ban or delay treatment on the basis of a patient’s weight or smoking status, unless this is backed up by evidence from NICE, a medical Royal College or other medical professional association.
