Changes to services: Understanding people’s experience of thresholds for elective surgery in York

Healthwatch York gathered public feedback on changes to the thresholds for elective surgery regarding body mass index (BMI) and smoking in York. This work was carried out following a survey that identified the issues that local people wanted Healthwatch York to look at – including these thresholds for elective surgery. Since January 2017 NHS Vale of York Clinical Commissioning Group (VoYCCG) has required that adult smokers quit and people over a certain weight reduce their BMI by a specific amount before being referred for surgery. Individuals still receive a referral for a consultant opinion, however they may have their referral for surgery delayed for six months and one year respectively, before they are put on a waiting list for most kinds of elective surgery under local or general anaesthetic.

Key themes drawn from people’s experiences included: all of those who took part reported negatively on the new thresholds and the various effects it had on their quality of life, health or wellbeing; people faced difficulties coping with pain in their day to day lives, and this led to them struggling to exercise and be active; some people faced financial and emotional distress due to being out of work and off sick for increasing amounts of time whilst waiting to access the surgery they need; people felt that the BMI threshold was arbitrary, and that they had received confusing or unclear messages from healthcare providers; and there was a lack of quality information and support about how to lose weight.

Healthwatch York made three recommendations to VoYCCG about: considering ways to gather the data needed to know if the thresholds for elective surgery are effective in saving money and improving patient outcomes; working in coproduction with the public to understand how to support people who have difficulty engaging with weight loss activities; and creating accessible and clear pathways of support, considering what proactive steps can be taken to prevent people from falling through the gaps, and to help more disadvantaged people engage with support programmes and services.