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    No surgery for smokers or the obese: Policy in UK stirs debate

    Two issues are the cause of a plethora of diseases and health conditions affecting people worldwide: smoking and obesity.
    And one local health committee in the UK has announced a controversial policy “to support patients whose health is at risk from smoking or being very overweight.”
    For an indefinite amount of time, it plans to ban access to routine, or non-urgent, surgery under the National Health Service until patients “improve their health,” the policy states, claiming that “exceptional clinical circumstances (will) be taken into account on a case-by-case basis.”
    The decision comes from the clinical commissioning group (known as a CCG) for the county of Hertfordshire, which has population of more than 1.1. million.
    The time frame for improving health is set at nine months for the obese in particular; those with a body mass index over 40 must reduce the number by 15% over that time period, and those with a BMI over 30 are given a target of 10%.
    The target for smokers is eight weeks or more without a cigarette — with a breath test to prove it.
    The new and most controversial part of the policy is that the surgery ban is indefinite, according to the Royal College of Surgeons in the UK, which opposes the policy. Other groups in the UK have implemented similar policies, but patients eventually get surgery if they are unable to lose weight or stop smoking, they said.
    “The guidance for (general practitioners) and providers has been in place since 2011 for hip and knee operations and was extended in 2012 to all non-urgent routine referrals,” the East and North Hertfordshire CCG said.
    Smokers had previously been advised to stop smoking and obese patients advised to lose weight, with both sets of patients informed about services available to them.
    CCGs are National Health Service bodies that plan health care services for their areas, and the groups for Hertfordshire argue that improving health before surgery improves outcomes and reduces the amount of time spent in the hospital during recovery, helping the patient — and the health service budget.
    Though the group says financial savings are not expected, “the wider health system may benefit from shorter hospital stays,” the CCG said.

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