Professor hits out at PCT cutbacks

A PROFESSOR at one of the world's top universities has condemned health bosses for introducing new clinical thresholds which deny obese patients hip and knee replacements.

By Danielle Nuttall

A PROFESSOR at one of the world's top universities has condemned health bosses for introducing new clinical thresholds which deny obese patients hip and knee replacements.

Stephen O'Rahilly, Professor of Clinical Biochemistry and Medicine at the University of Cambridge, accused health chiefs in east Suffolk of discrimination and described the decision as “systematic of a blame culture” towards the obese.

He was speaking out following the announcement that hospital consultants and GPs working in east Suffolk had come up with a list of 10 conditions where surgery will not be considered unless it meets certain criteria.


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The new thresholds mean that hip and knee replacement operations will not be performed unless a patient has a Body Mass Index (BMI) below 30 and other treatments, such as physiotherapy, have failed to alleviate pain.

Prof O'Rahilly described the BMI cut-off rate as “crude” and said actor-turned-politician Arnold Schwarzenegger, famed for his muscular build, would probably have a BMI of 30 or above.

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“It's not a very good measure of how fat you are. It makes an assumption all of us have a certain proportion of fat,” he said.

“A lot of power athletes would come in with a BMI of over 30. It's a silly cut off point. It's essentially systematic of a blame culture towards the obese.

“They are trying to claim it's a clinical decision. It's a crude form of rationing and it underestimates the difficulty that people have in losing weight. To deny those people pain-relieving treatment from a seriously disabling problem is discriminatory.”

Prof O'Rahilly said if health chiefs felt so strongly about the obesity problem - to the extent that they would deny surgical treatment - then they should pour in cash to help people lose weight.

“If you believe obesity is such a threat that it disallows you from having tremendous treatment, presumably you feel obesity should be aggressively treated?” he said.

“When people are seriously obese there is little or skeletal services to try and help people in East Anglia.

“Presumably they will pile money into obesity treatment programmes if they are not going to provide them with hip and knee replacements.

“It is primarily the duty of medicine to stop people being in serious pain. Often the hip and knee replacement is the only thing to stop them being in severe pain.”

But Ipswich Hospital spokeswoman Jan Rowsell defended the treatment thresholds, saying they had been drawn up by senior hospital consultants who are all specialists in their field.

“They are there as a guide. Every doctor treats a person as an individual,” she said.

“For the people who are unable to bring their BMI below 30 there is a whole range of help available to support people.

“That includes a very successful physio group at the hospital where patients are able to benefit from the expert help of physiotherapists.

“The whole aim of the treatment thresholds are to make sure patient safety is paramount.

“There are real risks for people who are carrying far too much weight if they have major orthopaedic operations. The risk of complications and thrombosis are much more heightened if you are not fit for surgery.”

The guidelines have been prompted by the crippling financial situation the NHS in Suffolk finds itself in, with health chiefs concentrating on ways of reducing demand for NHS services.

Other conditions affected by the new thresholds are the insertion of grommets in children, varicose veins, rectal surgery/investigation, carpal tunnel syndrome, Dupuytren's Disease, trigger finger, ganglion, prostatism or inguinal hernia.

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