A false economy? Surgeon warns too many obese patients are refused life-changing operations that would save NHS money
Hospital consultant calls for radical rethink on who gets ops and insists surgery could do more to combat Scots’ growing obesity problem
Too many obese patients across Scotland are being refused life-transforming operations, according to a leading surgeon.
The number of weight-loss operations, including gastric band and sleeve procedures, has fallen by more than 40% but surgeon Majid Ali believes more patients could be helped by surgery but are being ruled out.
Mr Ali, who runs the bariatric unit at the University Hospital of Ayr, a leading centre for weight-loss surgery, said his department, one of four in Scotland, accepts a broader range of referrals than most but still rejects most patients.
The number of operations has fallen from 270 on 2010 to about 159 in 2018, with the downward trend expected to continue. Mr Ali’s unit carries out approximately 30 operations a year but says the surgery, which costs less than £10,000 per patient, would save the NHS money in the long-term.
Mr Ali said: “In Ayrshire and Arran we reject more than 80% of patients who are not referred because they do not fit NHS National Planning Forum criteria. Obesity is a chronic and a complex disease. I would like to see the stigma attached to obesity addressed and more money allocated to bariatric surgery.”
The surgeon pointed out that obesity is now the biggest cause of cancer after smoking. And it can lead to heart disease and diabetes, as well as orthopaedic problems. He said bariatric surgery can cure Type 2 diabetes and help prevent other serious illness.
He wants to see bariatric procedures used as an integral tool in the fight to counter the obesity epidemic, alongside other measures such as physical and dietary education.
And he insisted the price of the procedures was a “drop in the ocean” when compared to the Scottish Parliament Information Centre’s estimated £600 million cost to NHS Scotland of overweight and obese patients.
Mr Ali insisted: “If the Scottish Government tackles the problem head on it will save money.”
Statistics released to The Sunday Post through NHS Information Services Division Quality Indicators reveal health boards in Scotland are now performing fewer weight-loss operations – from 270 in 2010/11 – when restrictive criteria for patient eligibility was set by the NHS Planning Forum – to 159 in 2018/19. The latest figures, up to March 2019, show the number of operations has dropped by 41%.
The Scottish Government has stressed there has been no change in criteria for bariatric surgery since 2012, and it was up to individual health boards to set their own spending priorities. But Mr Ali believes more action is needed. He said: “Scotland has one of the highest obesity rates in the world. The problem will only get worse.”
A Scottish Health Survey published in 2016 showed 29% of the Scottish population had a Body Mass Index (BMI) of at least 30, and so could be defined as obese. Two-thirds (65%) were overweight.
He said: “National Institute for Health and Care Excellence criteria says anybody with a BMI above 35, with
‘ Scotland has one of the highest obesity rates in the world. The problem will only get worse
medical conditions that can be cured or improved with the operation, is eligible for bariatric surgery, as long as they are fit for surgery and anaesthetic.
“When I introduced this surgery at this hospital in 2007 I opened the gate for everybody who fits NICE criteria. We got an influx of people and could not cope. So in 2010/11, with our colleagues in Scotland on the National Planning Forum we agreed on NHS criteria, which is a very restrictive criteria.”
Mr Alisaid: “If you have 30% of people in Scotland with a BMI above 30,
and you offer them surgery or other therapies, then you are saving money because you are saving orthopaedic operations and on treating patients with diabetes. Research has shown it is difficult to sustain weight loss once you hit a BMI above 30; surgery is the only way proven, just now, to sustain the weight loss.”
However, the Scottish Government rejected any suggestion that patients are being deliberately ruled out for surgery to save money. A spokesman said: “Bariatric surgery is a major operation and is just one of a range of weight management interventions for people living with obesity.
“The decision to offer bariatric surgery is jointly made between clinicians and patients, taking account of the National Planning Forum best practice and patients’ individual circumstances, including their fitness for surgery.
“Our Diet and Healthy Weight Delivery Plan supports better access to effective weight management services that lead to effective and sustained changes to people’s diet.”