Leading surgeons say a policy restricting weight loss surgery to a set of "super-obese" patients in Northamptonshire flies in the face of official advice.
A Freedom of Information (FOI) request made to health commissioning groups across the UK by the Royal College of Surgeons (RCS) and the The British Obesity and Metabolic Surgery Society (BOMSS) has found Northamptonshire is among seven areas with a policy to "ration" bariatric surgery - or gastric band surgery- for the county's overweight.
NHS Nene CCG, the group that decides on the country's healthcare spending, requires patients to have a Body Mass Index (BMI) of 50 or over, or over 45 where a pre-existing health condition such as diabetes is present.
However the National Institute for Clinical Excellence (NICE) and NHS England both recommend that gastric band surgery is available to those with a BMI of just 35 or above.
Consultant surgeon and BOMSS President, Shaw Somers, said: "Our survey reveals worrying evidence that some CCGs are effectively taking the law into their own hands and defying official guidance on surgical interventions which have been proved to help people with a serious medical condition and also save healthcare costs.
"It typifies the second-class citizen manner in which bariatric patients seem to be viewed by some CCGs.
"We are calling on NHS England and NICE to make it clear to CCGs that they must comply with the guidelines on who is eligible for this safe and effective treatment, not try to ration it in a misguided attempt to save money in the short-term.”
In all seven CCGs admitted they were not complying with the NHS England and NICE guidance. East Riding, Vale of York, and Nene CCGs are the only three that say patients must have a BMI of at least 50 before they will be considered for surgery.
Mid-Essex, however, is restricting treatment to non-smokers and North East Essex says smokers must be referred to a cessation service before they can be considered.
BOMSS and the RCS are warning this could harm patients and are demanding they revise their policies to bring them in line with the official guidelines.
The report showed that most CCGs have not yet adopted their own bariatric surgery policies - but will have to do so by next month under a phased government NHS reform.
Royal College of Surgeons president Clare Marx, said: “Study after study shows bariatric surgery is highly effective, particularly in treating type 2 diabetes associated with obesity.
"It is therefore astounding that commissioning groups are effectively indicating that obese patients should get even more obese before they will consider surgery.
"This makes no sense and contradicts our very strong public health messages about the benefits of losing weight."
The BOMSS and the RCS make five recommendations to health bosses.
- The seven CCGs with arbitrary requirements for bariatric surgery should revise their policies in line with national clinical guidance.
- NHS England should reiterate that access to NHS bariatric surgical treatment should be based on clinical need and uniform across the UK.
- NICE and NHS England should continue to highlight the benefits of bariatric surgery.
- NHS England should confirm that all CCGs will be responsible for commissioning bariatric surgery from April 1 to address the confusion over who is responsible.
- NHS England should provide CCGs with clinical guidance for commissioning bariatric surgery, in advance of the transfer of responsibilities.
- As well as calling on the seven CCGs to fall in line with guidance the RCS and BOMSS have pledged to review the policies of all CCGS once new commissioning rules are in place.