UK health system to ration joint replacements, fertility treatments

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From The DailyMail: Patients who are too fat could be denied routine operations to save money, revealed a survey of health service bosses.

More than a third of NHS trusts are considering rationing some types of surgery and other treatments.

Several have admitted they may impose ‘eligibility’ rules which could affect smokers as well as the overweight.

The criteria for accepting patients for operations would be based on their Body Mass Index, a measurement of obesity.

More than a third of health trusts are considering rationing some types of surgery and other treatments to save money, according to a new study

When senior managers at 67 Clinical Commissioning Groups – local health trusts – were asked, 39 per cent said they were planning to ‘limit access’ to routine treatment for financial reasons.

Procedures affected include varicose vein treatment, hip and knee replacement, and breast reduction surgery.

Others said smokers might be denied some treatments, most commonly IVF.

Senior doctors criticised the plans and accused health managers of denying patients vital treatment simply because they were considered to be ‘undeserving’.

When senior managers at 67 Clinical Commissioning Groups – local health trusts – were asked, 39 per cent said they were planning to ‘limit access’ to routine treatment for financial reasons.

Procedures affected include varicose vein treatment, hip and knee replacement, and breast reduction surgery.

Others said smokers might be denied some treatments, most commonly IVF.

Senior doctors criticised the plans and accused health managers of denying patients vital treatment simply because they were considered to be ‘undeserving’.

Dr David Paynton, of the Royal College of GPs, said: ‘Decisions about whether our patients are eligible for surgery or treatment need to be made on a case-by-case basis and by answering the question of whether surgery will benefit a patient’s long-term physical and mental health.

‘It should not be the role of CCGs to impose blanket bans on our patients’ access to surgery, nor to decide who is and who is not deserving of potentially life-saving treatments based on their lifestyle choices.

‘Of course, some surgical procedures cannot be performed on patients who are above a certain weight.

If we’re going to ration a service we should ration it for all people, not just those in particular groups and pretend it’s for clinical reasons. If it’s purely down to cost saving, it’s not ethical
Dr Richard Vautrey, chair of the BMA’s GP committee

‘In these cases, a clinical decision needs to be made about whether surgery would be beneficial if the patient lost weight and urgent steps would need to be taken to try and make this a possibility – but this is a separate issue.’

A Conservative Party spokesman said: ‘If health bodies stop patients from having treatments on the basis of cost alone, we will take action against them.’

Labour health spokesman Andy Burnham said increased rationing would lead to more patients having to pay privately.

‘Across the NHS, we are seeing a widening postcode lottery in access to treatment as financial pressures set in,’ he said.

‘The impact of this rationing plan is to expose the public to a greater range of charges for healthcare.’

There are 211 CCGs in England so the survey by the Health Service Journal covered just under a third.

Last year, Northern, Eastern and Western Devon CCG threatened to ban all non-urgent operations and treatments for anyone considered severely obese, with a BMI above 35.

This is equivalent to a 5ft 6in woman weighing 16st or a 6ft man being 18st 13b.

There was an outcry from patient groups and medical experts, including the Royal College of Surgeons, and the policy was subsequently dropped.

Obese patients could be denied varicose vein treatment, hip and knee replacement, pictured, and breast reduction surgery, while smokers could be banned from having IVF on the NHS

A separate survey by GP magazine last month found that 80 per cent of CCGs ration at least one procedure to patients who are very obese.

Some claimed surgery was less effective for the obese, they took longer to recover or that the anaesthetic was high risk.

Dr Richard Vautrey, chairman of the British Medical Association’s GP committee said at the time: ‘It’s blatant rationing.

‘CCGs should be open. If we’re going to ration a service, we should ration it for all, not just those in particular groups and pretend it’s for clinical reasons.

‘If it’s purely down to cost saving, it’s not ethical. There are clearly cases where certain people’s body size may make it difficult to safely do a certain procedure, but they’re exceptional.’

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