Treat obese patients before terminally ill, says government adviser
A GOVERNMENT adviser and leading surgeon has suggested that NHS funds would be better spent on providing surgery for morbidly obese patients than on palliative care for the terminally ill.
Andrew de Beaux, a consultant weight loss and gastric surgeon at Edinburgh Royal Infirmary, believes it is unfair that some patients in the last few months of their life are given expensive treatments while obese patients are denied potentially life-saving operations on the NHS and could enjoy the health benefits for many years.
De Beaux said most people in the UK regard obesity as being a self-inflicted condition from eating too much, which is reflected in the small number of patients offered weight-loss surgery on the NHS in Scotland – just 200 cases in 2011.
The expert, who advises the Scottish Government on obesity issues and is an honorary clinical senior lecturer at Edinburgh University, said many overweight people have a genetic condition that causes weight gain and that it is virtually impossible for them to lose it and keep the weight off long term without surgical intervention.
But it is his comments on who should be eligible for NHS funds that have angered charities who deal with palliative care, church leaders and some politicians, who believe choices should not have to be made as to whether one group of patients should be treated at the expense of another.
De Beaux said: “There are a lot of expensive drugs used to prolong life sometimes over a few weeks to months. I would question whether this money may be better spent by helping very overweight people lose weight.”
In 2010, almost two-thirds of men aged 16-64 and more than half of women in Scotland were classified as either overweight, obese or morbidly obese – 10 per cent higher than in 1995. In addition, more than 150,000 children are now classified as obese.
The problem is getting worse, de Beaux said, with many thousands more people in Scotland now being classed as morbidly obese, making them eligible for consideration for gastric surgery. Yet only around 200 weight loss operations are being carried out in Scotland every year compared to around 10,000 in Sweden.
The surgeon said: “Treating just 200 cases a year will make little impact on the size of the problem. For the majority of patients, their chance of being offered surgery is very slim indeed, but the likelihood of many of these people suffering chronic conditions as they age is very high.
“This is both costly and time-consuming for the NHS and thus society. If people did more joined-up thinking now and these people were given the drastic help they needed to lose weight it would actually save the NHS a great deal of money in future years. It would also improve these peoples’ health and give many people a life they could never even dream of in their obese state.
“I would recommend we look at what is happening in Sweden, a country just about twice the size of Scotland, for the answer to our growing obesity crisis. It is clear officials there are looking to the long term in terms of quality of life and cost savings.
“There is a belief by many, including some health care professionals, that obesity surgery is cosmetic, but for most patients, this is not the case. They have a medical need for it. It is not just about looking and feeling better, it is about improving the quality of life and allowing such patients to reach old age.
“Like any operation, surgery is not without risks, but gastric surgery works and the majority of patients who have it will, on average, lose about 60 per cent of their excess weight in two years.”
De Beaux is one of a small number of surgeons in Scotland offering patients weight loss surgery, including the well-established “gastric band” procedure and a new technique called the “gastric sleeve.”
The gastric sleeve involves using key-hole surgery to remove around 85 per cent of the stomach and takes just an hour to carry out. De Beaux and his team carry out about four of the sleeve operations on the NHS and at a private hospital every week.
Gastric surgery is backed by guidance including that produced by the Scottish Intercollegiate Guidelines Network (SIGN). But the cost – up to about £5,000 per patient for the surgery, with follow-up care an additional cost – means the surgery has so far been limited in Scotland.
De Beaux’s comments provoked a strong reaction yesterday. A spokesperson for Help The Hospices said: “The hospice sector feels strongly that NHS investment is hugely important for palliative care. We would not agree with these comments. We don’t call for more investment from the NHS for palliative care but we do call for fairer investment.”
Sally Foster Fulton, the convener of the Church of Scotland’s Church and Society Council, said: “Mr de Beaux’s illustration is a dangerous one to make. Human flourishing and dignity must be top of the list for outcomes in the NHS budget. To suggest that palliative care should be the area that is cut is an unhelpful distraction from the real issue of how we care best for all folk living in the UK.”
Scottish Conservative health spokesman Jackson Carlaw: “It’s a very, very ill-judged remark. You don’t catch obesity on a train. It’s an avoidable condition and we all want to do everything we can to reduce levels of obesity and where we can intervene surgically all to the good, but people who are suffering from terminal conditions, given the very clear public preference for the best quality end of life possible, should be given every support with palliative care. This should not be an either/or between obesity and those dying with terminal conditions.”
A Scottish Government spokeswoman said weight loss surgery is available on the NHS for those who need it. “Our focus is on encouraging everyone in Scotland to improve their diet and take more exercise to prevent obesity in the first place,” she said.
“The NHS exists to provide high-quality care to people whenever they need it. We aim to improve care for the terminally ill, not cut it.”
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