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Surgery being rationed to save money

Author: Gail Harris

We all accept that the NHS is under pressure to cut its astronomical deficit and meet ever tightening targets, but are some patient groups becoming scapegoats?

Some reports suggest that as many as 60% of NHS Trusts are restricting access to surgery for smokers and the obese. One Trust has gone even further and banned all treatments for anyone with a Body Mass Index (BMI) above 35 in an attempt to reduce its £14.5m shortfall.

Further restrictions include instructing patients with a BMI of 35 or above to shed 5% of their body weight before they can be considered for surgery for routine procedures such as joint replacements or even tonsillectomies, whilst smokers have to quit at least 8 weeks before surgery. And a total of 30 Clinical Commissioning Group’s (CCG) have refused to fund IVF for women with a BMI in excess of 30.

The moves are not welcomed by senior doctors who have branded them as ‘blatant rationing’.

Dr Richard Vautrey, deputy chair of the British Medical Association’s GP committee, said managers were using ‘spurious clinical reasons ‘to discriminate against some patients. He added: “If we’re going to ration a service we should ration it for all people, not just those in particular groups and pretend it’s for clinical reasons. If it’s purely down to cost saving, it’s not ethical. There are clearly cases where certain people’s body size may make it difficult to safely do a procedure, but they’re exceptional. I think what’s happening here is overt rationing to save money.”

The Royal College of Surgeons has also aired concerns about the move saying that it was storing up ‘greater pressures’ for the future. It added: “Losing weight or giving up smoking is an important consideration for patients to improve their outcomes, but for some patients these steps may not be possible. A blanket ban on scheduled operations for those who cannot follow these measures is unacceptable.“

Dr David Haslam, chair of the National Obesity Forum said: “What we hate as GP’s is blanket bans and you can’t just take BMI as a reason to operate or not.”

Public Law and Judicial Review solicitor, Angela Sandhal, comments: “We recognise that a rising population and the fact that people are living longer will inevitability have an impact on NHS resources. However, it is unsatisfactory for CCGs to have blanket policies in place which prevent doctors from making appropriate decisions about their patients based on their clinical judgement. Policies of this kind are very likely to be susceptible to judicial review which has proven successful in other similar cases.”

Do you believe your surgery has been delayed or cancelled because of your weight or because you are a smoker? Talk to us. We are experienced public law specialists and can give you the expert advice and support you need. Call 01302 320621 or email

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