NHS funded surgery
NHS funding is a complex issue. In December 2006, the National Institute for Clinical Excellence (NICE) published new guidelines recommending that surgery be made available for patients, but the government did not allocate any specific pot of money to cover the costs of surgery, or to set up a national network of multidisciplinary bariatric surgery teams. This is an area that is being addressed, but it could take a considerable amount of time and is hampered by the prejudices about obesity that exist throughout our society. There are many new treatments for a huge range of diseases that compete for funding and because many people still do not appreciate that obesity is a life–threatening disease, it may be put lower on the funding priority list.
Funding for patients on any surgical treatment waiting list generally comes from annual contractual agreements between the NHS Trust (the hospital) and the Primary Care Trusts (PCTs). Bariatric surgery almost always falls outside of the standard surgery contracts.
In some areas of the country, the PCTs have worked together and commissioned one or several hospitals in their region to provide bariatric surgery services. They may have set aside a certain amount of funding and told the bariatric surgery team that they will fund patients in the current financial year up to the limit of that pot of funding. With banding costing £5–7,000 and bypasses costing £8–14,000 the bariatric surgery team then has to allocate that money across all the patients they are referred for surgery. It can be disappointing if you come along just when the pot has all been used up.
In other areas, the money for surgery has to be taken from the same pot as other obesity treatments and so again, there have to be decisions taken whether to fund people for drug therapy, dietary and exercise programmes of surgery.
In most PCTs each patient for whom surgery is proposed is still considered and approved on a case–by–case basis, usually by a committee called a 'Limited Intervention Panel' or an 'Exceptional Treatments Panel'.
In January 2008, we audited the criteria that PCTs use to approve funding for surgery. Check out what your PCT's criteria are here and we will continue to update this information.
Improving access to obesity surgery services across the UK is a core objective of BOSPA. If you are one of the unlucky ones for whom funding is not already available, it is an area you will have to become active in too - remember that word empowerment that we said was the ethos of BOSPA, well many patients who have had surgery in the past few years have not just sat back and expected someone else to lobby on their behalf, they have been proactive about it themselves. But it can be frustrating for surgical teams if a patient arrives at the clinic pre–approved for a gastric band before they have undergone the pre–operative assessment - that operation might not be the one that is best for you and in some cases, it is hard to go back to the PCT for different funding. Here are some steps you might like to consider if bariatric surgery is not easily available to you.
- Check what the local criteria are for funding of surgery on our chart. Ensure you have your GP's support and commitment to you being referred for this treatment and this may entail helping them to learn all about it if it is new to them too. Make sure you can honestly say are also doing everything yourself to prepare for this treatment - e.g. you've researched it thoroughly and been in contact with a local patient support group.
- Contact you local PCT and enquire where patients who meet the criteria are being treated - if the bariatric surgeon or hospital they respond with are outside your locality, your GP may have to seek permission to refer you to the hospital (called an out–of–area referral) for assessment. Ask the PCT what their protocol is for funding surgery.
- The bariatric surgery multidisciplinary team will then usually apply to the PCT for funding for your surgery, depending on which type of operation you are going to have etc. Sometimes the surgeon will write back to your GP and confirm that you are suitable for xx operation, and ask your GP to go through the process to secure the funding.
- Contacting your MP and local newspapers is going to put pressure on your PCT but should only be considered if you have tried all the steps above and not received a satisfactory response.
We are happy to help BOSPA members with this activity and have had some considerable success to date approaching PCTs and higher health authorities around the country on a member's behalf.