1) What are your trust’s criteria for qualifying for NHS funded weight-loss surgery?

2) How many patients from your trust’s area had gastric band surgery on the NHS in the past three years (August 2011-August 2014)?

– Please breakdown each case by year/ age/ gender/ pre-op weight.
3) How many patients from your trust’s area had gastric bypass surgery on the NHS during the same period?
– Please breakdown each case by year/ age/ gender/ pre-op weight.
4) In the last three years how many patients have received revision surgery on the NHS following a complication resulting from weight-loss surgery?
– Please breakdown by year/ age/ gender/ pre-op weight.
5) How many patients in question 4 had previously been treated privately in the UK or abroad?
– Please breakdown by year/ age/ gender/ pre-op weight.

Q1 We apply National (NICE) criteria as dictated by NHS England (NHSCB/A05/P/a) – below.

Eligibility for bariatric surgery

Surgery will only be considered as a treatment option for people with morbid obesity

providing all of the following criteria are fulfilled:

 The individual is considered morbidly obese. For the purpose of this policy bariatric surgery will be offered to adults with a BMI of 40kg/m2 or more, or between 35 kg/m2 and 40kg/m2 or greater in the presence of other significant diseases.

 There must be formalised MDT led processes for the screening of co-morbidities and the detection of other significant diseases. These should include identification, diagnosis, severity/complexity assessment, risk

stratification/scoring and appropriate specialist referral for medical management. Such medical evaluation is mandatory prior to entering a surgical pathway.

 Morbid/severe obesity has been present for at least five years.

 The individual has recently received and complied with a local specialist obesity service weight loss programme (non surgical Tier 3 / 4), described as follows:   This will have been for duration of 12-24 months. For patients with BMI > 50 attending a specialist bariatric service, this period may include the stabilisation and assessment period prior to bariatric surgery. The minimum acceptable period is six months. The specialist obesity weight loss programme and MDT should be decided locally. This will be led by a professional with a specialist interest in obesity and include a physician, specialist dietician, nurse, psychologist and physical exercise therapist, all of whom must also have a specialist interest in obesity. There are different models of local MDT structure. Important features are the multidisciplinary, structured and organised approach, lead professional, assessment of evidence that all suitable non invasive options have been explored and trialled and individualised patient focus and targets. In addition to offering a programme of care the service will select and refer appropriate patients for consideration for bariatric surgery.

The Bariatric Surgery Team will satisfy itself that:

 Bariatric surgery is in accordance with relevant guidelines

 There are no specific clinical or psychological contraindications to this type of

surgery

 The individual is aged 18 years or above.

 The patient has engaged with non-surgical Tier 3 / 4 Services.

 The anaesthetic and other peri-operative risks have been appropriately

minimised

 the patient has engaged in appropriate support or education groups/schemes to understand the benefits and risks of the intended surgical procedure

 the patient is likely to engage in the follow up programme that is required after any bariatric surgical procedure to ensure

 Safety of the patient,

 Best clinical outcome is obtained and then maintained.

 Change eating behaviour

 Change physical behaviour as advised

 The overall risk: benefit evaluation favours bariatric surgery

Questions 2-4 are answered on the attached. FOI 3,268  We do not hold the relevant information to be able to answer Q5.