Bariatric surgeon Shaw Somers said move by local NHS in Vale of York amounts to discrimination because obesity is an illness

The decision by an NHS body to restrict obese patients’ access to elective surgery until they lose weight is comparable with racial or religious discrimination, a surgeon has said.

The Vale of York clinical commissioning group (CCG) will make people wait for up to a year for treatment for non-life-threatening conditions such as hip and knee replacements if their body mass index is 30 or higher.

The group said it had taken the decision because it was the “best way of achieving maximum value from the limited resources available”.

Shaw Somers, a bariatric surgeon from Portsmouth, said the move was a logical step and could save money, but amounted to discrimination because obesity was an illness.

“They [the patients] are trying to lose weight in the vast majority of cases and to deny them treatment that they need on the basis of their weight, without then offering them effective help to help them lose weight is rather like discriminating [against] a segment of the population on the basis of their colour or religious persuasion,” he told BBC Radio 4’s Today programme.



“Just saying you can’t have surgery and there is no access to alternative treatments really doesn’t help anyone.”

Chris Hopson, the head of NHS Providers – which represents acute care, ambulance and community services – said the move amounted to “rationing care to save money”.

He told Today that the health service was being asked to deliver too much for the funding available. Rather than commissioning groups making “piecemeal decisions”, Hopson said there should be a national debate about the future of the UK’s healthcare system involving not only politicians, NHS leaders and clinicians – but the public as well, given that tax revenues funded it.

Demand for healthcare was “about to go through the roof” as baby boomers neared the end of their lives, he said. There had been a 6% increase in emergency admissions in the first quarter of this year.

The Royal College of Surgeons (RCS) said that it was a dangerous move that ranked among the “most severe the modern NHS has ever seen”.

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Its president, Clare Marx, said that while the RCS supported helping people to lose weight and stop smoking, “introducing blanket bans that delay patients’ access to what can be life-changing surgery for up to a year is wrong”.

She added: “As the true scale of financial pressure on NHS trusts has become clear over the summer, we are fast finding ourselves in a situation where CCGs are introducing draconian commissioning policies, often flouting Nice [National Institute for Health and Care Excellence] or other clinical guidance, in order to balance the books.

“An honest national debate on exactly what the NHS can afford, and what we are willing to pay, is urgently needed.”

The Vale of York is one of nine clinical commissioning groups in England that face acute financial problems and have been forced into special measures. Five hospital trusts are also expected to overshoot their budgets by a wide margin this year.

There are fears that more parts of the NHS could start to impose similar restrictions on elective care in an attempt to balance the books. The health service had record overspending of £2.45bn in 2015, but NHS bosses hope that cuts will bring the figure down to nearer £250m by the end of this year.

The Vale of York group said: “The local system is under severe pressure. This work will help to ensure that we get the very best value from the NHS and not exceed our resources or risk the ability of the NHS being there when people really need it.”

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Policy documents produced by bosses in the North Yorkshire authority make clear that adult smokers will have elective surgery postponed “for six months or until they’ve stopped smoking for eight weeks”.



And, for people whose BMI is 30 or more – who are defined as obese – such treatment will be put back a year “or until 10% of weight loss is achieved, whichever is the sooner”.

The CCG added that, in either case, “patients undergoing surgery for cancer will not be affected” and its clinicians would “identify other groups of patients who should be exceptions to the policy”.

In March last year, it was reported that the vast majority of NHS authorities were placing restrictions on access to surgery for overweight people, including one CCG that was refusing all routine surgery to people whose BMI was 35 or greater – those defined as morbidly obese. The investigation by GP magazine also found that most of England’s CCGs were denying some treatments to smokers.

A spokesman for NHS England said: “Major surgery poses much higher risks for severely overweight patients who smoke. So local GP-led clinical commissioning groups are entirely right to ensure these patients first get support to lose weight and try and stop smoking before their hip or knee operation. Reducing obesity and cutting smoking not only benefits patients but saves the NHS and taxpayers millions of pounds.

“This does not and cannot mean blanket bans on particular patients such as smokers getting operations, which would be inconsistent with the NHS constitution.

“Vale of York CCG is currently under special measures legal direction, and NHS England is today asking it to review its proposed approach before it takes effect to ensure it is proportionate, clinically reasonable, and consistent with applicable national clinical guidelines.”