Today’s blog comes courtesy of Professor Paul Gately. He has very kindly allowed me to post his comments on access to weight-loss surgery and Tier 3 programmes after their discussion on this week’s Channel 4 Dispatches programme called ‘Britain’s Big Fat Bill’. Take a read about he has to say in favour (or not) of surgery and the Tier 3 Programmes which should support the decisions for surgery or not through their participation. Lots makes sense – what doesn’t, of course, is the patchy access to such services throughout the country. Do you agree with his stance, what has been your experience…comments are very welcome.
“Should we make it easier to get weight loss surgery?” – 26 November 2013
By Professor Paul Gately
The practice of providing weight loss surgery to severely obese patients has been in the news a lot recently and last night’s Dispatches: Britain’s Big Fat Bill, highlighted it once again. Earlier this year, NHS England introduced new guidelines to standardise national access to weight loss surgery. In Big Fat Bill, we saw some surgeons criticising these guidelines for unnecessarily delaying surgery. That’s understandable, as surgery is an effective option for many morbidly obese patients. It can be a genuine lifesaver and saves the NHS money in the long run if applied in the right way. In fact the guidelines are sound – it’s the implementation that’s the problem.
According to the guidelines, severely obese patients – those who qualify for bariatric surgery – are required to participate in a Tier 3 weight management programme before they have the procedure. This programme can be provided by the NHS or through a company like MoreLife, but either way it should focus on the needs of the individual and be overseen by a multidisciplinary team including doctors, dietitians, psychologists and exercise experts.
These non-surgical programmes are not just a formality, and they’re not just an effort to make weight loss surgery less appealing. On the contrary, they’re critically important because they can help many patients prepare appropriately for surgery if necessary; there is research showing that fitter people have better outcomes from surgery. Tier 3 programmes also provide high quality support for those that have not been successful on slimming clubs and now need more comprehensive and clinical support which may help them avoid surgery. Finally there is strong evidence that surgery is not appropriate for people with some psychological or mental health conditions. For this group, Tier 3 services are the only effective option available.
Unfortunately, Tier 3 programmes are highly variable depending on where you live. Early this year the Royal College of Physicians described these services in England as “patchy.”, and the Dispatches programme showed us a map that proved it. The findings were that in many regions these patients are simply sitting on a waiting list or going on an inadequate weight management service because there has been no investment by their local authority or Clinical Commissioning Group.
The bottom line is that government has not provided leadership on this issue and the consequence is that neither CCGs nor local councils believe it is their job. They must invest in clear and effective obesity pathways on a national level, where surgery is just one element and used only where it is most appropriate.
MoreLife has helped to deliver weight management services in Essex and Oxfordshire, leading to a 50% reduction in the number of people accessing bariatric surgery as they have lost and continued to lose weight. This has saved money and helped many more people find the services most appropriate to their needs, and is a great example of what happens when authorities move forward with a strong, proactive vision.
I hope that in the long run, the UK’s health services will take responsibility and make these complete pathways available across the country. It’s not about restricting access to weight loss surgery, it’s about having an appropriate and effective care pathway, so people don’t have to jump straight to surgery. Not only is this morally appropriate for a civilised society, but it makes economic sense too!