Number of patients waiting for gastric band surgery and costs of the procedure

1240/5(2994)

WRITTEN QUESTION TO THE MINISTER FOR HEALTH AND SOCIAL SERVICES BY DEPUTY G.P. SOUTHERN OF ST. HELIER

ANSWER TO BE TABLED ON TUESDAY 26th SEPTEMBER 2006

Question

Would the Minister inform members –

1. of the numberof patients, if any, currently awaiting surgery toputinplace a gastric band' together with the cost ofsuchoperations?
2. whether funding for this procedure has been agreed and, if not, the reasons whytogether with the timescale for resolution ofany funding difficulties, if any? and,
3. whether any guidelines are in place that specify if such operations are treated as essential for reasons of ongoing health of the patient rather than as a cosmetic procedureoflower priority?

Answer

This question is timely, given the publication of the Medical Officer of Health's Annual Report - 2006 on Friday 22nd September. While this report makes clear that there have been many successes in improving the health of Islanders, there is a great deal to be done if Islanders are to enjoy the optimum level of health and wellbeing. The Medical Officer of Health report is frank and candid about the major health risks and challenges which Jersey must confront; not least the bleak prospect of having to manage obesity (and diabetes) which the report describes as the 21st Century epidemic'. Obesity and being overweight increases the very real risk of patients acquiring the big killer' diseases, including heart disease, cancer and diabetes. I draw little comfort from the fact that while Jersey is experiencing a marked increase in the level of obesity, it has not yet reached U.K. levels.

It is in this context that we must consider bariatric surgery (or gastric band' surgery). Bariatric surgery is a technique by which a gastric band' (a metal band) is placed around the stomach to effectively reduce the size of the stomach and thereby limit the intake of food by the patient. This radical surgical intervention is deemed to be the last resort' to prevent morbidly obese people becoming so obese that they suffer internal organ failure which can result in death. Bariatric surgery is an expensive surgical intervention and is relatively new, hence the numbers of surgeons who are able to perform this technique to a high level of competence are still few and far between. For many years to come, comprehensive bariatric surgical services will only be provided from U.K. major tertiary centres. In the short to medium term at least, the prospect of comprehensive bariatric surgical services being provided from local general hospitals, such as the Jersey General Hospital, is unlikely.

Clearly, the requirement for bariatric (gastric band) surgery increases as the phenomenon of increased morbidity in the population increases generally. While the Health and Social Services Department has in the past been able to secure surgery for a small number of patients on a case-by-case basis, the numbers now presenting for treatment in Jersey is such that the Department is not funded for this surge in demand without distorting other pressing health and social care priorities. This is a major political, as well as clinical, challenge for the States of Jersey.

Having set the context, it is now possible to provide detailed responses to the three questions asked as follows –

1. There are  approximately  40  patients  awaiting bariatric  surgery and  the cost  of each intervention  is approximately £10,000per patient. The Health and Social ServicesDepartment has been referring patients to tertiary centres in the U.K. for approximately two and a half yearsnowon an adhoc basis. However, the numbersofpatientsnow presenting will require the establishment of a partnership arrangement with one such centretoensure that a clearclinicalpathwayforpatientsisinplaceand a dialogue with such a provider to that endisnowunderway.Four of the 40 patients are seeking private surgery. A further four patientsof

the 40 have not complied with the assessment protocols required prior to that surgery and therefore cannot be

considered for surgery at this time.

2. As Minister for Health and Social Services, I have not yet agreed funding priorities for 2007.However,the full funding for bariatric surgery for all thosepatients requiring it is unlikelytobeagreed in 2007 for two reasons. Firstly, because of a range of other important competing priorities. These competing priorities include funding for new cancer drugs,improvedaccommodationforpatients at two of the wardsat Overdale Hospital, andthesecond year tranche of resourcesto improve servicesforlooked after and adopted children. Secondly, because a groupofmanagers, consultants and nurses are nowexamining the options as to how this form ofsurgery should be provided (see (a) above), this work will be included in a businesscasewhich the Waiting List Project Board will consider. Until this work is completed, the HealthandSocial Services Department will continue toseekand fund bariatric surgery for the most extreme ofcaseswherethelevelof morbidity is such that itislife-threatening.
3. In the contextof the above,theHealthandSocialServicesDepartment deem bariatric surgerytobe an important health care intervention requiredby certain patients if their quality oflife is to be significantly improved.Giventhe very nature ofmorbid obesity in Jersey it is self-evident that bariatric surgery ismost certainly not a cosmetic' procedure. (The Health and Social Services Department more generally does not allow for cosmetic surgery at thetaxpayers' expense inany field of medicine or surgery). The factors which determine the suitability of a patient for bariatric surgery are highly complex. They most certainly include a psychological assessmentas bariatric surgery requires patients to comply with anexactingregimefortherest of their lives and some patients are unable tocomprehend or manage this. Offundamentalimportanceis the need to search out far less radical procedures before clinicians and theirpatientsfeeltheneedtoconsider this ultimate and radical intervention.