NHS Rations IVF and Surgery for Smokers and Obese with New Wave of Lifestyle Restrictions

GP commissioners and NHS managers across England are targeting smokers and the obese with a raft of new restrictions limiting patients' access to treatment unless they modify their lifestyles, Pulse reveals.


More than a quarter of PCTs are reporting that new restrictions on surgery based on lifestyle criteria have been introduced in their areas over the past year. But some GPs claim the restrictions are discriminating unfairly against patients, and a senior lawyer warned they could be open to legal challenge on equality grounds.

Freedom of Information responses from 91 PCTs show 25 have brought in new restrictions on treating obese patients or smokers since April 2011, not counting rationing of bariatric surgery. Eleven have introduced restrictions on hip and knee replacements, while nine have targeted IVF. Others have restricted nipple inversions, breast reconstruction and open MRI scans.

The Peninsula health technology commissioning group, covering Cornwall, Devon, Torbay and Plymouth, is now banning both men and women from undergoing IVF treatment unless they have been non-smokers for at least six months.

NHS Bedfordshire has barred obese patients from hip and knee surgery until after they have lost 10% of initial body weight or moved below BMI 35' while NHS North Essex requires patients to have lost at least 5% weight and have maintained that 5% weight loss for at least six months'.

NHS Hertfordshire, which caused controversy last year by banning hip and knee operations for patients with a BMI of more than 30 and for smokers until they attend a smoking cessation course, has now extended the policy to all routine surgery.

Ben Troke, partner at Browne Jacobson LLP, warned the restrictions would have to be drafted carefully to avoid having any discriminatory effect, in appearance or reality, on any particular groups in society'.

The public-sector equality duty, under s149 of the Equality Act 2010, would apply to CCGs in just the same way as it currently applies to PCTs,' he said.

Dr Clare Gerada, chair of the RCGP, said some of the restrictions, particularly for IVF, were dreadful': It's becoming the deserving and the undeserving. I think it's discriminatory and I find it astonishing. The Government should determine what should be applied universally.'

Steve Nowottny, deputy editor of Pulse, said: Rationing in the NHS is nothing new but PCTs and clinical commissioning groups are increasingly taking the decision to ration care based on patients lifestyle choices.

In some cases there may be genuine clinical justification for rationing treatment on these grounds. But there is a growing suspicion that some PCTs are now blocking access to surgery for smokers and the obese simply to help achieve ever-greater efficiency savings. Such a policy has disturbing implications - and GPs are increasingly uneasy about the NHS providing a second-class service to patients with less healthy lifestyles.

Pulse, the leading website and magazine for GPs

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