'Unfair' restrictions catching one-in-five patients

The measures put in place by health chiefs in Scarborough and Ryedale are expected to be replicated in other parts of the region in coming months as the NHS struggles to balance the books.

A total of 79 people out of 408 patients have so far been refused referral to hospital for routine hip and knee replacements because they smoke or are deemed obese since restrictions in the area were introduced in mid-November.

Patients face a delay of up to six months for referral while they lose weight or quit smoking.

Restrictions for routine surgery have also been imposed in other parts of North Yorkshire and the East Riding and are due to be implemented across South Yorkshire from this month as part of measures designed to save cash.

The Yorkshire Post can today reveal growing controversy over the limits has prompted bosses at NHS England to order local officials to give four weeks’ notice of any new plans to allow them to be reviewed and to explain them to the public.

Last night the Royal College of Surgeons strongly criticised the “unfair” restrictions by Scarborough and 
Ryedale Clinical Commissioning Group (CCG), warning they could cost the NHS more money in the long run.

Its vice president, Stephen Cannon, said: “It is disgraceful that one in five 
patients are having what can be life-changing surgery delayed for at least six months based on what are 
frankly arbitrary criteria - especially given if they lived elsewhere in the country, they could have their surgery.

“Patients requiring hip and knee surgery will often be in debilitating pain and will likely struggle to walk making the weight loss the CCG 
requires to perform surgery near impossible.

“While it is absolutely right that the NHS looks at how it can support obese patients to lose weight and smokers to stop smoking, the policies this CCG has instigated are unfair and leave patients suffering unnecessarily.”

Mr Cannon said the last six months had seen “similar brutal restrictions” rolled out in areas across England.

He added: “The irony is that these policies are often introduced in an effort to save money, all the while costing the NHS more money, over a longer period, as they provide pain medication, physiotherapy and other support, while patients wait for their eventual and inevitable surgery.”

Figures published by the CCG show in addition to the 79 facing delays under the new restrictures, a further 11 hip and knee patients were turned down on other grounds which can include assessments classing them as being in insufficient pain.

It has now emerged that managers in the region were last month ordered to give NHS England officials at least four weeks’ notice of further restrictions.

A letter to CCGs from David Black, joint regional medical director at NHS England, said: “This will enable NHS England 
to support and assure your work, brief regional and national colleagues in advance and ensure that the CCG communications are supported by NHS England and include consistent messages.”

He added: “We are very supportive of your work to best manage resources for the benefit of all patients and understand that this may mean that difficult decisions need to be made.

“We expect that many CCGs will be in the process of developing similar schemes and 
initiatives to deliver plans for 2017-19.

“This is something we would encourage, where plans are well developed and clinically validated.”

Official advice for obese patients and smokers in Scarborough and Ryedale warns them they are at greater risk of complications during and after surgery and their recovery also takes longer.

It says the restrictions are part of wider measures to improve health in the area amid evidence hospital admissions linked to smoking in Scarborough remain “stubbornly high”.

Deaths from heart disease and stroke connected to smoking are among the highest in England.

It predicts the measures will lead to a drop in non-urgent hospital surgery and “will help the CCG meet its financial targets amid a challenging climate for the NHS, not just locally, but nationally”.

The CCG fell into the red last year and is predicting a deficit of £5.3 million in the coming 12 months despite savings measures including the clinical restrictions.

Figures produced by the IPPR thinktank earlier this year suggested the NHS in Yorkshire was facing a £2bn funding gap by the end of the decade. Existing plans to save cash include proposals to reduce stroke units and the number of hospitals carrying out operations on children.