Last week’s decision to stop surgery for obesity in St Vincent’s University Hospital was taken after a meeting between the HSE and senior members of the board of St Vincent’s. It is a telling reflection on the state of our healthcare system. Leadership is absent and chaos currently reigns.
Here we have an operation that saves lives, improves quality of life and is cost-saving within a short timeframe. Only kidney transplantation is more cost-saving (mainly due to reduced dialysis costs). During a time of major financial pressures, these procedures should be prioritised – as they are in the majority of healthcare systems.
Benefits
Over the years, I have spoken to most of the individuals who would have been involved in taking this decision and they all have acknowledged the financial and health benefits of the surgery (the international evidence is clear in the right patients). How, then, can the system they work in allow a decision to axe this service? The answer isn’t clear.
The decision is so unreasonable that one has to wonder if it isn’t down to a common problem that has beset dysfunctional organisations over centuries – arguments between poorly communicating sections. I think this is the case. The HSE management has been upset with St Vincent’s for some time. St Vincent’s – as a working environment – has been a relative oasis of clinician-management engagement and performance within the health service until the last year. The HSE is gradually dragging it into the fold of bickering and inactivity that it currently seems to be striving for as the new norm.
Now, our health service that claims to want to save lives and money and be there for the socially disadvantaged has made a decision that shows that it is itself that is in need of radical surgery.
Class issue
Obesity is now clearly a social class issue, with three times more, and in turn more extreme, obesity present by the age of three in the lower socio-economic groups. Certainly less public sympathy will be generated by the decision to stop surgery for obesity than a failure to approve a new drug for cancer or cystic fibrosis.
We accept and rightly applaud rapid access clinics for lung cancer (genes plus industry-driven smoking), but as a health system we discriminate against the obese (genes plus industry-driven nutritional lifestyle) – and remove their treatments. Fat fools.
The truth is that surgery for obesity has been limping along at well below the international norms in Ireland. Between Francis Finucane’s unit in Galway and our own, we barely touched 100 surgeries last year. International data suggests we should be doing a minimum of 1,000 per year and more likely twice that.
In tough financial times, healthcare rationing is, and must remain, a major challenge for the healthcare system, but surely the focus must be on the high-cost, low-return areas, such as the final 10 days of life where we spend a disproportionate amount of money for little return overall. Cutting a service like surgery for obesity makes no medical or economic sense.
I represent a team of healthcare professionals and patients. Over 180 of these patients have been told that they need surgery for their obesity – news that many of them did not want to hear – but they do need the surgery and it will improve their length and quality of life. More than 1,300 patients await a review at our outpatient programme – average age 43 years, average weight 133kg (21 stone).
These patients have been offered an approach to weight management and have been given an expectation that something can be done. Cutting the surgical arm of our obesity service means we cannot meet this expectation much beyond a super-intense Weight Watchers programme that is very high on healthcare professional input. The HSE will deny that there are more than 180 awaiting surgery. It is wrong – there are 191 as of this week.
Reverse decision
We now need a decision-maker to emerge from the chaos and reverse this decision to stop obesity surgery in St Vincent’s. That might involve leadership, someone raising their head above the parapet, and speaking with clarity. I fear that may be too much to ask.
Later this week, the Healthy Ireland Council will meet for the first time. This is a first and really positive step in developing a wellness system in this country. I would much rather be discussing that development exclusively and how it can help prevent childhood obesity.
Instead, until the decision to deny our patients life- and cost-saving surgery is reversed, I will have to continue to highlight that act of stupidity.
Donal O’Shea is consultant endocrinologist, associate professor of medicine, St Vincent’s & St Columcille’s hospitals, University College Dublin