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Written Statement - Bariatric Surgery

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Lesley Griffiths, Minister for Health and Social Services 

The Welsh Health Specialised Services Committee (WHSSC) is currently undertaking a review of bariatric surgery policy.  Bariatric surgery is a specialised service and WHSSC is responsible for the planning and delivery of specialised and tertiary services in Wales.  WHSCC is independent of the Welsh Government and is required to make decisions in terms of how NHS Wales funding is spent.

Obesity rates in the UK are amongst the highest in Europe.  Medical interventions have proved unsuccessful in reversing obesity once present. Surgery has proved to be both clinically and cost effective and, as such, has been endorsed by the National Institute for Health and Clinical Excellence.  In Wales in 2011, 57% of adults were classified as overweight or obese, including 22% obese.  The rise in the prevalence of obesity (BMI >30) amongst adults in Wales is slowing down (1% over the last 5 years). However, prevalence, and current trends, of excess weight are still unacceptably high. We need to keep the momentum going to prevent adults and children facing deteriorating health and a lower quality of life and we are facing spiralling health and social care costs.

The review will assess the impact of health outcomes and costs to NHS Wales of adopting the NICE guidance for bariatric surgery.  

The main NICE criteria applies to individuals who have had access to non-surgical intervention but have failed to achieve clinically beneficial weight loss.  This emphasises the importance of the non-specialised levels of the obesity pathway and that implementing NICE guidance for bariatric surgery must be linked to implementing the full pathway.  

The criteria in Wales have been developed to focus the scarce resource currently available for bariatric surgery on the most at risk group.   The growth in demand and the pace of development of services means there will always be limits on the services which can be secured at any point in time.

The Welsh Government approach provides a strong emphasis on patient engagement in decisions about their care so they can fully understand potential risks and benefits and make informed choices.  Surgery, either gastric band or gastric by-pass, is funded only when a patient meets specific clinical criteria.  The criteria have been set to ensure only those patients with the greatest ability to benefit have access to surgery and funding is, therefore, restricted to those with pressing health issues.  

Clinical assessment and suitability for surgery undertaken by a Multi-Disciplinary Team Panel, includes physical and psychological considerations, as well as the requirement that weight loss goals and lifestyle changes are agreed before surgery is considered.  

Only patients who meet the clinical criteria are funded for treatment.  A small proportion of all patients referred for assessment have the surgery.  Furthermore, up to 40% of patients drop out, despite having funding agreed, when they have the procedure and the potential complications of bariatric surgery explained.  Clinical assessment of eligibility is undertaken by the Welsh Institute of Metabolic and Obesity Surgery (WIMOS), based at Morriston Hospital, Swansea, acting as a gatekeeper for Wales.  It is there a Multi-Disciplinary Team panel is convened to consider referrals from across Wales.  However surgery may be undertaken either in Swansea or in Salford for North Wales patients once approved.

The aim of the review is to recommend options to the Joint Committee for the revision of the current bariatric surgery policy.  Any proposals to extend access to bariatric surgery will be considered as part of the WHSSC prioritisation process for the 2012/13 plan.  Any proposal will be made in the context of a comprehensive, integrated obesity pathway, in order to ensure the benefits of surgery are fully realised.  

I have been informed the review will be completed by the end of December 2012, followed by a paper for the WHSSC Joint Committee in January on policy options.  Bariatric surgery is included as part of the WHSSC prioritisation work to inform the annual plan.  


This review will be considered in the context of the all Wales Obesity Pathway, which sets out a four tiered approach for the prevention and treatment of obesity, from community based prevention and early intervention to specialist medical and surgical services. Local Health Boards working jointly with Local Authorities and other key stakeholders have mapped local policies, services and activity for both children and adults against four tiers of intervention and identified gaps. LHBs need to be implementing local solutions for the gaps that they have identified in relation to the first three tiers.

Providing the review is completed by the end of December as anticipated, I will provide a further update on the findings of the review by the end of January 2013.  

This statement is being issued during recess in order to keep members informed.  Should members wish me to make a further statement or to answer questions on this when the Assembly returns I would be happy to do so.