East Suffolk PCT critiscised by doctors
A DECISION taken by NHS trusts in east Suffolk to deny hip and knee replacement surgery to obese patients was criticised by doctors today.Last month it emerged obese people would not be entitled to such surgery on the NHS in east Suffolk, as part of a series of measures to save money.
A DECISION taken by NHS trusts in east Suffolk to deny hip and knee replacement surgery to obese patients was criticised by doctors today.
Last month it emerged obese people would not be entitled to such surgery on the NHS in east Suffolk, as part of a series of measures to save money.
It is believed the risks of operating on obese patients are higher and the treatment may be less effective, with replacement joints wearing out sooner.
But Nicholas Finer, a consultant in obesity medicine at Addenbrooke's Hospital in Cambridge, challenged claims that surgery could be withheld on the grounds of increased risks for obese people.
Dr Finer, writing in the British Medical Journal today, said: “No evidence supports withholding joint replacement from obese people, even on utilitarian grounds.”
He said for knee replacements there was “no evidence that age, gender or obesity is a strong predictor of functional outcomes”.
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Dr Finer said another assessment had concluded that relative body weight alone did not influence the benefit derived from hip replacement surgery.
He added: “Since obesity does not increase the risks or diminish the benefits of joint replacement, the trust's decision to deny such treatment seems to be based on prejudice or attribution of fault, or both.
“Logically extended, such a policy would deny treatment to, among others, smokers, most patients with HIV infections, and those who sustain sports injury.”
Retired doctor Martin McNicol said delaying operations on “punitive” grounds may increase long-term costs. He said the measure to limit surgery to obese patients was “rationing by any other name”.
“What is the evidence that these strict conditions are not in the longer term damaging?” Dr McNicol asked.
Last week a report by the Government's treatment watchdog said patients could be denied treatment in some cases if lifestyle factors such as smoking or being obese make it ineffective.
The National Institute for Health and Clinical Excellence (NICE) said doctors should avoid discriminating against patients with conditions that are, or may be, self-inflicted.
But their report said that if self-inflicted factors meant that drugs or treatment would be less clinically and cost-effective, this may need to be considered when producing advice for the NHS.
Dr Brian Keeble, director of public health for Ipswich PCT, said: “Our work on clinical thresholds has been a key part of this process.
“We started from the idea that operating on some conditions, either at an early stage or before other treatments have been tried, could actually be detrimental to the patient because of the risk of side effects from the procedure.”
“We cannot pretend that this work wasn't stimulated by the pressing financial problems of the NHS in East Suffolk.
“Different doctors have different opinions and our thresholds were based on the clinical opinion of our orthopaedic consultants.”