Smokers and obese Londoners could be refused surgery in bid to save NHS cash

Health reporter(wp/es):

Smokers and obese Londoners could be refused surgery and IVF treatments axed in a radical bid to save NHS cash.

Richmond and Croydon are considering whether to end funding of fertility treatments or limit it to “exceptional cases”, such as people left infertile by cancer treatments.

Richmond clinical commissioning group (CCG) is also proposing to ban smokers and people with a Body Mass Index (BMI) over 40 - those classed as “severely obese” - from non-emergency surgery.

Operations would only proceed if they lost at least 10 per cent of their body weight in nine months or achieved a BMI under 30, meaning they were just “overweight”.

Smokers would have to make “genuine supported steps” to quit or achieve a particular goal before their operation would be allowed to proceed.

Health campaigners today warned the “appalling” draft restrictions on fertility treatment broke NHS recommendations for three cycles of IVF, while the Royal College Of Surgeons said restricting access to surgery was “totally unacceptable”.

Richmond, which needs to save £11 million this year, plans to reduce initial eligibility for IVF to women up to 40.

A consultation proposes “significantly increasing the threshold” to the point where “IVF and specialised fertility treatment is no longer commissioned”.

Croydon CCG, which needs to save £30 million, last week began consulting on a proposal to stop “routine IVF”. 

It currently offers one free cycle. Private fertility treatment typically costs about £3,000 per cycle.

About 250 women a year would be affected. The changes would save a total of about £1.2 million.

Susan Seenan, chief executive of the charity Fertility Network, said: “It’s completely wrong of them to be cutting such a vital service for people who have a medical issue that stops them conceiving.”

Restrictions on surgery for obese patients and smokers in part of Yorkshire have already been approved by NHS England. Those who fail to lose weight or quit face delays of between six to 12 months.

A Royal College of Surgeons spokeswoman said: “Obese patients should be encouraged to lose weight before surgery for their overall health. 

“However making it a condition of receiving that treatment is totally unacceptable and we urge the CCG against such a policy. We are not aware of any clinical evidence to suggest patients are more likely to lose weight if the NHS denies or delays treatment.

“Richmond CCG has been upfront in admitting their proposals are also aimed at reducing financial pressures. However, patients may be left suffering in unbearable pain and in some cases delays could lead to their symptoms worsening so it is difficult to see how this will save significant money. 

“We encourage the CCG to reconsider how it can save money without targeting specific groups of patients and affecting their access to healthcare.”

Richmond CCG has already agreed to reduce access to knee surgery, bunion surgery and treatment for gallstones, and reduce the number of operations to remove tonsils and varicose veins.

It also wants to reduce the amount of prescriptions for baby milk, vitamin D tablets, gluten-free food and “self-care” medication such as paracetamol and antihistamines.

Dr Graham Lewis, chairman of Richmond CCG, said: “Increasing demands on NHS services means that we cannot provide everything we want for people living in the borough of Richmond. 

“We have to prioritise and make difficult decisions, which include a proposal to reduce the number of IVF cycles offered from one to an exception only basis, to secure the future of local health services for everyone.”

In relation to the proposed restrictions on surgery, Dr Lewis said: “There is a lot of evidence to demonstrate that not all patients gain improvement in their symptom levels or mobility from undergoing operations such as hip or knee replacements and other treatments, such as physiotherapy, may be more effective. 

“In addition, being overweight and smoking are factors which contribute to poorer outcomes, so it makes sense to reduce these risks before surgery.”

A Croydon CCG spokeswoman added: “The proposals were brought about in light of the financial pressures the local NHS is facing. NHS Croydon CCG needs to make savings of almost £30 million next financial year, which is around six per cent of the commissioning budget for local health services of £482.3 million.”

Richmond’s consultation will run until 3 February, with Croydon’s running to 1 March.