Soft targets? Overweight people and smokers bear the brunt

© Shutterstock / Marbury

Smokers and patients considered overweight are becoming ‘soft targets’ for NHS savings, according to the Royal College of Surgeons. 

These categories of patients are sometimes being denied treatment because of their size, or the fact that they smoke. 

It has been revealed that more than a third of CCGs (Clinical Commissioning Groups) in England are being refused or delaying routine surgeries until their status changes, according to a new report. 


Even common routine procedures such as hip or knee replacements are being affected, which goes against national guidance. 

Labour’s Shadow Health secretary, Heidi Alexander MP, said the report was evidence of the NHS’s financial crisis.

“It’s utterly unacceptable for people to be waiting in pain and discomfort for an operation because of an arbitrary restriction, which isn’t in the best interest of their own or the nation’s health,” she said.

President of the college, Clare Marx, said: “Blanket bans that deny or delay patients’ access to surgery are wrong.

“NHS surgical treatment should be based on clinical guidance and patients should be dealt with on a case-by-case basis. 

“In some cases patients might need surgery in order to help them to exercise and lose weight.”

Two hundred health bodies took part in the Freedom of Information survey (information open to the public by law), and it revealed that 34% had policies restricting access to surgery by someone’s BMI or whether they smoke. 

Over one-fifth of the surgeries set upper weight limits on patients who were looking for either hip or knee replacements, which is an increase of 13% compared to 2014. 

Clare Marx continued: “While it is difficult to categorically prove such policies are aimed at saving money, it is unlikely to be a coincidence that many financially challenged CCGs are restricting access to surgery. 

“Our worry is that smokers and overweight patients are becoming soft targets for NHS savings.”

Some CCGs require BMI to be under 30 – the limits for obesity – or patients are referred for weight management before qualifying for surgery. Equally, some CCG also require patients to attend quit-smoking classes prior to surgery. 

President of the British Orthopaedic Association, Tim Wilton, explained that this had no place in clinical care.  

“There is no clinical, or financial, justification for refusing to fund hip or knee replacements based on BMI or smoker status,” he said.

“Good outcomes can be achieved for patients regardless of whether they smoke or are obese, even at BMIs of over 50, and these surgeries are highly cost effective: typically delivering sustained pain relief for a cost that equates to just £7.50 a week.

“Hard-and-fast rules also undermine the NHS’s ability to involve patients in decisions about their own care.”

Although many people agree that patients should be in the best shape possible before undertaking costly surgery, is it right that people are waiting in pain before they are even allowed to have the surgery? The debate continues on. 


Please enter your comment!
Please enter your name here