Rationing of weight management services undermines health efforts

http://www.theguardian.com/society/2015/jul/20/rationing-weight-management-health-nhs

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People who are dangerously overweight are being denied vital help because weight management services are being rationed to save money, despite rising obesity, public health experts have revealed.

Access is also being restricted to exercise programmes, NHS health checks, mental health services and efforts to help smokers quit, according to new research by the Royal Society for Public Health.

In a survey it conducted of 100 public health officials working for the NHS and local councils just under half (49%) said that weight management programmes had been rationed in their area in the last year. Almost as many (44%) had seen restrictions placed on the availability of exercise referral programmes, which help people with diabetes or heart problems adopt healthier lifestyles.

Experts claimed the rationing would undermine efforts to counteract expanding waistlines. “To ration nationally agreed weight management programmes is both short-sighted and quite stupid. It could well be unethical if patients’ hope of returning to good health is prejudiced,” said Tam Fry, a spokesman for the National Obesity Forum.

UKactive, which promotes physical activity, said limiting exercise referral programmes, in which GPs give patients a programme of regular exercises, was hard to understand given the known benefits of tackling sedentary behaviour.

“These findings are extremely worrying,” said Steven Ward, its executive director. “Being physically active can treat, prevent or manage 20 lifestyle diseases, such as diabetes and heart disease. This is a time for an industrial-scale rollout of services, not for reducing already established services.”

Over a third (35%) said access to NHS health checks had been limited in their area, while 32% had seen child and adolescent mental health services rationed, despite the sharp recent rise in concern about their unavailability.

“Our research suggests that funding cuts are beginning to bite and are having a direct impact on frontline services,” said Shirley Cramer, the RSPH’s chief executive.

“Obesity, which NHS England chief executive Simon Stevens has called ‘the new smoking’, is arguably the number one threat to both the public’s health and our NHS. But people on the frontline are reporting that some of our most effective weapons aimed at tackling this threat, such as exercise referral and weight management services, are being restricted.”

Denying patients who need access to such services create future problems in the form of worse health outcomes and higher NHS costs, she said.

Sexual health services have also been rationed, 28% of respondents said. One said they had been unable to address issues of men having sex with men because of funding pressures, while another warned that rationing would create “increased unplanned pregnancies with a knock-on effect on families and society”.

Smaller numbers reported seeing rationing of services for those with alcohol problems (28%), drug addicts (27%) and smokers (26%). One RSPH member said rationing drug and alcohol services would increase petty crime and the number of people ending up in prison, as well as a greater likelihood of suicide and serious health problems.

The findings come as public health professionals brace themselves for the impact of the public health budget being cut by £200m by the Treasury. Leading experts have warned that it could lead to more sexually transmitted infections, unplanned pregnancies and other damaging health outcomes.

Duncan Selbie, chief executive of Public Health England, suggested the findings were linked to austerity affecting public health services.

“The survey is only a snapshot at a single moment in time of the full range of public health local services across the country and we need to be cautious about making wide-ranging extrapolation,” he said. “The fact is, the entire public sector is under pressure. Resources are scarce, and health services – from the NHS to local authorities – are having to manage constrained budgets and rising demand.”