Concerns are growing that more troubling stories about the National Health Service will emerge before it fully recovers from the effects of a decade of underfunding and the lasting impact of the coronavirus pandemic. Today, award-winning health correspondent Rebecca Thomas reports that obese patients are being denied essential hip and knee replacements as part of cost-cutting measures. In one-third of NHS areas in England and several health boards in Wales, patients with a body mass index (BMI) above a certain threshold are being refused surgery—despite this contradicting guidance from the National Institute for Health and Care Excellence (NICE), which is responsible for assessing the cost-effectiveness of treatments.
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Naturally, any system with finite resources must make difficult decisions. All costly NHS treatments are rationed—albeit not by ability to pay, as is often the case elsewhere, but usually through waiting times and clinical prioritisation. NICE plays a crucial role in helping decide who should receive treatment first. Some parts of the NHS argue that obesity itself causes joint issues, and therefore weight loss should precede surgery to ensure long-term effectiveness. However, this reasoning oversimplifies the complex relationship between obesity and mobility.
NICE rightly recognises that in many cases, joint pain and immobility contribute to obesity, not simply the other way around. For some, joint replacement surgery is not just pain relief—it is the key to regaining mobility and achieving sustainable weight loss through exercise. While new weight-loss medications like Ozempic are offering alternative pathways for some, this must not lead to broad, discriminatory bans on surgery based on rigid BMI limits—especially when those thresholds vary inconsistently across different NHS regions.
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There is cautious optimism that the new government intends to reverse the NHS’s decline. Chancellor Rachel Reeves is expected to confirm significant increases in NHS funding during the 11 June spending review. Health Secretary Wes Streeting has claimed early progress, pointing to falling waiting lists over recent months, although this has been partially contradicted by fact-checkers. As tough choices continue to confront the NHS, doctors must remain vigilant against blanket exclusions that unfairly disadvantage patients based on weight. Ensuring equity in access to care should remain a guiding principle as the system rebuilds.
