'cure for type-2 diabetes being denied to 98% of eligible scottish patients'
As a piece of table-thumping rhetoric, the title above is alarming, but maybe shock tactics are needed to help overcome one of Scotland’s biggest healthcare problems. Duff Bruce introduces this issue’s feature section
"There are many dedicated professionals across Scotland who are delivering a great service, albeit with limited resource, but, most importantly, are prepared to support a new, expanded strategy to help this difficult and often disenfranchised population"
Other Feature focus articles:
Patients with severe and complicated obesity form one of Scotland’s fastest growing and difficult to manage populations. Responsible for a disproportionately larger share of the annual £171million cost of treating the comorbidities associated with obesity than any other cohort, this group’s management is confounded by lower access rates to bariatric surgery than almost any other country in the world.
The best use and development of Scotland’s limited resource of bariatric surgery is a complex logistic and ethical issue. With the data available to show that patients with type-2 diabetes often go into remission following a bypass, we are, as nation, essentially withholding an intervention which could potentially cure not just sufferer’s obesity but also much of their metabolic comorbidities.
As Carel le Roux and Dimitrios Pournaras outline, the health economic outcomes of bariatric surgery are not only positive, but significantly better than non-surgical management, are sustained over at least 15 years, and can essentially be cost-neutral within three years. Diverting NHS funding to support an expanded service, however, will require more than simply demonstrating the economic benefits. Justification must be made for the funding diversion, as must a national treatment network and an integrated team of professionals and specialities to manage these difficult patients.
Outlined in Ingmar Naslund’s excellent article is an example of how a reprioritisation of bariatric surgery in Sweden has helped to focus on identifying patients who are likely to have the best outcomes for the health service and the patient, whilst Iain Broom outlines the importance of providing a seamless patient pathway from assessment, through intervention to long-term patient care.
In Scotland, to help address this issue, the Severe and Complicated Obesity Treatment Service (SCOTS) is working towards creating equitable access for all those willing and eligible patients in Scotland. We don’t expect it to be easy, however. It will require improved co-ordination of the NHS obesity service, diversion of funds from less critical interventions and the demonstration of clinical and health economic benefits. The challenge for Scotland is, however, that it has one of the most obese populations in the world and yet one of the lowest bariatric surgery intervention rates. There are many dedicated professionals across Scotland who are delivering a great service, albeit with limited resource, but, most importantly, are prepared to support a new, expanded strategy to help this difficult and often disenfranchised population.
As an intervention which can essentially ‘cure’ type-2 diabetes, how long can we continue to ignore the evidence? The responsible course for Scotland must include strategies to ensure the best and fairest use of the existing resource for the management of the entire population of severe and complicated obesity sufferers whilst developing clinical networks within which multi-disciplinary teams enjoy increasingly prioritised access to well-trained and supported bariatric surgeons. Scotland may have a unique opportunity to fight corpulence with excellence!
SCOTS
SCOTS (Severe and Complex Obesity Treatment Service) is an independent multidisciplinary group, combining experts in the fields of surgery, endocrinology, dietetics, psychology and health economics, set up to improve the treatment for patients with severe and complex obesity in Scotland. The group aims to provide equitable access to bariatric surgery for all eligible and willing patients. A sister group, ESCO (Experts in Severe and Complex Obesity), was launched in England in October at the National Obesity Forum Annual Conference.