NHS heads reject demands for rethink over operation delays

As reported in the Yorkshire Post yesterday, routine surgery funded by NHS Harrogate and Rural District Clinical Commissioning Group (CCG) is to be delayed by six months for patients who smoke or those with a Body Mass Index (BMI) of 30 or more.

The CCG, which needs to save £8.4m, will refer affected patients to weight management or stop smoking services for a six-month period of “health optimisation” before they will be considered for non-urgent operations.

In September, NHS England intervened to stop neighbouring NHS Vale of York CCG from imposing a similar but more stringent policy after the Royal College of Surgeons (RCS) raised concerns that proposals went against clinical guidance.

Following the decision in Harrogate, the RCS said they hoped NHS England would again step in to stop patients from being “targeted”. Ian Eardley, vice president of the RCS, said: “The policies for smokers and overweight patients that Harrogate and Rural District CCG intend to impose ignore the public outcry that surrounded similar plans announced by neighbouring Vale of York CCG in September.

“They fly in the face of the intervention made by NHS England to prevent those plans from going ahead. The Royal College of Surgeons is very supportive of encouraging patients to join programmes that help them lose weight or stop smoking before surgery.

“However making it a condition of receiving that surgery, no matter how sick they are or how much pain they are in, is wrong. NHS England has already said that denying operations to a particular group – such as smokers – is ‘inconsistent’ with the NHS constitution. NHS trusts and CCGs are desperately looking for ways to save money in very challenging times but singling out groups of patients is not the way to do it. We hope NHS England will now step in to prevent Harrogate and any other CGGs from targeting patients in this way.”

However a spokesman for NHS England said the proposals had been considered and were consistent with “clinical guidelines”, so there will be no further review.

The spokesman said that promotion of healthy lifestyles would enable people to live longer, healthier lives.

“When reviewing these proposals NHS England needs to satisfy itself that they are proportionate, clinically reasonable and consistent with applicable national clinical guidelines,” he said.

“Harrogate and Rural District CCG’s approach is to clearly support its patients to achieving better health and clinical outcomes by referring them to an established weight loss program or smoking cessation service.

“This is consistent with national clinical guidelines.”

The new guidelines in Harrogate would not apply to those needing surgery for cancer or suspected cancer, people undergoing diagnostic procedures, children, frail elderly people, those with severe mental illness or a learning disability.

Last month, the Vale of York CCG agreed to delay non-life threatening surgery by a year for smokers or those with a BMI exceeding 30. However NHS England intervened and the move is being reviewed. Similar measures were discussed by Scarborough and Ryedale CCG last week.