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Access to surgery

Lack of commissioning is denying patients access to bariatric surgery

Fall of 10% in the number of bariatric surgical procedures performed between April 2012 and March 2013, even though the most recently available statistics show obesity rates in England continue to rise.

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

“It is concerning that patients are being denied access to treatment due to weight assessment and management clinics not being commissioned,” said Mr Richard Welbourn, President of the British Obesity and Metabolic Surgery Society. “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.”

Previously, 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 that individuals try and exhaust 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.

However, recent Hospital Episodes Statistics data shows there was a fall of 10% in the number of bariatric surgical procedures 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.

"To hear that a postcode lottery is emerging in UK weight management provision is deeply worrying and 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,” said Professor Norman Williams, President of the Royal College of Surgeons. “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 clinical commissioning groups to reduce this sort of variation and drive up standards of patient care across the UK."

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 is the second time in four years A RCS report has found geographical location is a factor as to whether a patient will gain access to bariatric surgery.

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