Failure by the NHS to provide cost-effective surgical treatment for morbid obesity is costing the wider economy hundreds of millions of pounds a year, according to a report by the Office of Health Economics for the Royal College of Surgeons of England, National Obesity Forum, Allergan and Covidien.
The report, entitled Shedding the Pounds, analyses Government data, National Institute for Health and Clinical Excellence (NICE) clinical guidelines, and reviews the published medical literature to show that a major increase in the number of bariatric surgery operations would pay for itself in one year by enabling many patients to return to paid employment. The OHE analysis estimates the number of patients getting access to surgery and showed:
• If just 5% of eligible patients were to receive bariatric surgery, the net gain to the economy within three years would be £382 m.
• If 25% of eligible patients were to receive bariatric surgery, the net gain to the economy within three years would be £1.3 bn.
• The UK Government could also expect savings in benefit payments in the region of £35 m to £150 m.
• Direct healthcare cost savings of around £56 m per annum to the NHS in reduced prescriptions and GP visits if NICE guidance was followed.
It is now well established that a postcode lottery exists in UK obesity surgery provision. The report also obtained data, under the Freedom of Information Act, which shows that many Primary Care Trusts (PCTs) are either ignoring NICE guidelines and rationing care for all but the most severely ill patients, or offering no provision at all. The report shows that, of those who responded:
• Half of PCTs use only “elements” of the guidelines set out by NICE guidance to determine who qualifies for bariatric surgery.
• One in ten PCTs ignore the guidance completely.
• Three quarters of PCTs do not track the outcomes for patients of bariatric operations.
• One third of PCTs said they would be more stringent with patients when applying the rules; and none said that guidance would be applied less stringently – effectively resulting in further cuts.
• Huge variations in the numbers of procedures carried out per year between Trusts, ranging from just a single procedure in one PCT in 2009/10 to 192 in another.
NICE guidelines state that morbidly obese patients – those with a Body Mass Index (BMI) of 40 or more, or those with a BMI of 35 or more and other illness, including diabetes, hypertension, heart disease and sleep apnoea – have a right to be properly assessed for weight loss surgery. However, many PCTs limit access to surgery by simply raising the bar so that only the most seriously ill patients – those with a BMI of 50 or 60 – qualify for surgery. John Black, president of the Royal College of Surgeons, said: “These figures are staggering. The NHS can not afford to ignore the mounting evidence that shows that bariatric surgery, for those patients where all other treatments have failed, is not only proven to be successful but also hugely cost effective.”
