Page last updated at 07:59 GMT, Thursday, 21 January 2010

NHS obesity operation access inconsistent, surgeons say

Jane Dreaper
Health correspondent, BBC News

Fat man measuring his waist with tape measure
The number of complaints about obesity surgery in private hospitals went up rapidly in the past two years

Access to weight-loss operations on the NHS is "inconsistent and unethical", the Royal College of Surgeons has said.

The RCS says some patients who meet the criteria for stomach surgery of England and Wales health watchdog NICE have to wait until they become even more obese.

It estimates the 4,300 operations such as gastric band fittings carried out by the NHS last year met only 2% of need.

The NHS Confederation said primary care trusts had to balance local needs and priorities while planning services.

Private hospitals

The RCS warning comes as the Medical Defence Union (MDU) releases figures showing a rise in the number of compensation claims by obese people who have suffered complications after private stomach operations - including one death.


There is absolutely no doubt that some patients more needy of surgical treatment than others are being denied it

Peter Sedman, surgeon


There are no centrally collected figures for complications after NHS weight-loss surgery.

The RCS has launched a national registry for these operations to try to get a better picture of what is happening.

It says access to stomach surgery on the NHS is "inconsistent, unethical and completely dependent on geographical location" - despite guidelines issued by NICE three years ago, which aimed to provide consistent treatment in England and Wales.

David Stout, director of the NHS Confederation's PCT Network, told BBC Radio 4's Today programme PCTs had "very strict guidelines" about when weight-loss operations should be given, but every PCT had to make a choice on local priorities.

"In each case we have to look at what we do first between competing priorities in the local area - cancer, mental health, maternity and so on.

"It is important to get the strategies right, to focus on the local area and not a national average," he said.

He said most PCTs were allowing access to surgery in "certain circumstances", but it was important to be "transparent and open".

Surgeons have accused some NHS trusts of raising the bar, so that only the most extremely ill patients are being referred for operations.

Hull-based surgeon Peter Sedman said: "There is absolutely no doubt that some patients more needy of surgical treatment than others are being denied it.

"Sometimes, unless the patient moves house, they will not be referred - or if they are, the treatment is subsequently blocked."

The RCS says about 240,000 people want weight-loss surgery - yet only 4,300 NHS operations were carried out last year.

A similar number are carried out in private hospitals every year.

Growing demand

The MDU's figures show that since 2003, there have been 35 compensation claims for weight-loss surgery paid for privately - 21 of them have been in the past two years.

Obesity patient describes complications

In at least one case a patient died following an infection, which was allegedly caused by the gut being perforated.

Another patient had to be put on a ventilator after a leak following a gastric bypass led to an infection.

Other problems involved gastric bands slipping or leaking.

The MDU, which insures doctors, says most of the claims are still ongoing, with the estimated value of each one ranging from £2,500 and £500,000. Not all cases will result in payouts.

Its chief executive, Dr Christine Tomkins, said: "These claims aren't surprising, given that this type of surgery is fairly new.

"There's usually a time lag between an incident occurring and a claim being made.

"We want to try to help our members avoid some of the common problems we're highlighting."

Demand for the operations continues to grow each year. One company, BMI Healthcare, said it was seeing a 20% year-on-year increase.

Experts warn that surgery to tackle obesity is a medical procedure, rather than a cosmetic operation.

A Department of Health spokesman said: "Independent guidance on obesity from the National Institute for Health and Clinical Excellence recommends that drugs and surgery should always be a last resort."



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