Weight restrictions for surgery on the rise in England

An increasing number of overweight patients in England are being denied surgery, despite this going against national guidelines on clinical best practice.

213 local clinical commissioning groups (CCGs) responsible for planning and purchasing healthcare services in England, were asked whether they limited funding for surgery on the basis of body mass index (BMI).

Of the 170 CCG policies analysed, 133 (62 per cent of all CCGs) confirmed they were using patients’ BMI to limit which surgeries they would fund. Restricted treatments included hip and knee replacements; breast reduction; varicose vein surgery; and other plastic surgery including removal of excess skin.

The National Institute for Clinical Excellence (NICE) which sets out guidelines for the health service, explicitly points out that factors such as smoking and obesity “should not be barriers to referral” in relation to joint surgery. For plastic surgery, whilst there are studies which show higher rates of complications for patients with exceptionally high BMIs, NICE have not set out specific guidelines.

A spokesperson for NHS England, said “For many medical conditions, treatment is safer and more likely to work if you’ve first got to a healthier weight.

“However, ultimately these are legally decisions for local GP groups to take, and they have to decide the best way of spending the budget Parliament has allocated the NHS.”

However, the Royal College of Surgeons have concerns that patients are being left in unnecessary distress and pain.

The college’s vice-president Ian Eardley, said “It’s the blanket nature of the restrictions that is the most worrying. No doctor would say it’s not a good idea for someone who’s overweight to lose some of that excess weight, but it should be an individual assessment.”

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Posted by Karen Motley, Clinical Negligence Department, Chadwick Lawrence LLP (tonymay@chadlaw.co.uk ), medical negligence lawyers and clinical negligence solicitors in Huddersfield, Leeds, Wakefield and Halifax, West Yorkshire.

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