Postcode lottery is denying obese patients access to vital treatment

Patients are being denied access to bariatric surgery because intensive weight loss programmes, which are a prerequisite to surgery, are not being commissioned in some areas, the Royal College of Surgeons and the British Obesity and Metabolic Surgery Society warns.

A lack of provision in some parts of the country is leaving obese patients unable to access the vital services they need to control their weight which could potentially put their health at risk.

Last year, NHS England, which is responsible for commissioning bariatric surgery, published a clinical commissioning policy on the specialised management of severe and complex obesity.

The published policy reflects NICE guidance that recommends individuals have tried and exhausted all non-invasive treatment options prior to potentially higher-risk surgical approaches. As part of this, it requires patients to complete support from weight management services (called ‘tier 3’ support) which helps them to succeed in controlling their diet post-surgery.

Recent Hospital Episodes Statistics data shows there has been a fall of 10% in the number of bariatric surgical procedures being performed between April 2012 and March 2013, even though the most recently available statistics show obesity rates in England continue to rise.

The RCS is concerned that the current problems with commissioning weight management has led to a further fall in the number of bariatric procedures, as these programmes are a prerequisite for referral to bariatric surgery.

Richard Welbourn, President of the British Obesity and Metabolic Surgery Society (BOMSS), said:

‘It is concerning that patients are being denied access to treatment due to weight assessment and management clinics not being commissioned. The benefits of bariatric surgery are well-known. It leads to greater body weight loss and higher remission rates of type 2 diabetes than non-surgical treatment of obesity. Poor access to bariatric surgery therefore places some patients at continuing health risk. In the long run this will end up costing the NHS more.’

BOMSS, in conjunction with the College and other partners including the Royal College of Physicians, has produced NICE accredited commissioning guidance for weight assessment and management programmes. The guidance is intended to assist clinical commissioning groups in commissioning these services and reduce variation in access to these clinics across the country. This guidance is due for publication at the beginning of this year.

Professor Norman Williams, President of the Royal College of Surgeons, said:

‘To hear that a postcode lottery is emerging in UK weight management provision is deeply worrying. The fact that access to surgery is blocked because of this means the NHS is simply storing up problems for later and compromising patient care. The Royal College of Surgeons and Specialty Associations’ commissioning guides give commissioners a clear understanding of what cost- effective quality care should look like. We hope to work with CCGs to reduce this sort of variation and drive up standards of patient care across the UK.’

Notes to editors

 The Royal College of Surgeons of England is committed to enabling surgeons to achieve and maintain the highest standards of surgical practice and patient care. Registered charity number: 212808.

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