Bariatric Surgery

Martin James Keatings made this Freedom of Information request to Greater Glasgow NHS Board

This request has been closed to new correspondence from the public body. Contact us if you think it ought be re-opened.

The request was successful.

Martin James Keatings

Dear Glasgow NHS Board,

I am seeking information pursuant to the Freedom of Information Act with regards to NHS Glasgow Clinical Guidelines with respect to the Roux en-Y gastric bypass procedure.

In particular I am seeking NHS Glasgow policy on the requirements of progressing to surgery, specifically with regards to pre-operative weight reduction.

My question is:

If a person has a BMI high enough to warrant a gastric bypass; and
If the person suffers from comorbities, specifically type 2 diabetes and sleep apnoea; and
serious disability prevents the person from obtaining a 5% weight loss (or weight loss target required by NHS Glasgow);

Would NHS Glasgow proceed with said surgery?

Yours faithfully,

M. Keatings

FOI BOARD HQ, Greater Glasgow NHS Board

Dear Mr Keatings

 

Freedom of Information (Scotland) Act 2002

FOI Request: Our ref 13458: Policy on Gastric Bypass Procedures:
Acknowledgement

 

We refer to your request for information, shown below in your email.

 

We are dealing with it under our procedures for responding to requests for
information under the Freedom of Information (Scotland) Act 2002 and will
endeavour to reply to you within 20 working days.  If you wish to know how
matters are proceeding with your request, please do not hesitate to
contact us quoting our reference 13458.

 

Yours sincerely,

Kay Dougans

 

Freedom of Information Officer

NHS Greater Glasgow and Clyde

Corporate HQ

J B Russell House

Gartnavel Royal Hospital Campus

1055 Great Western Road

Glasgow G12 0XH

 

[NHS Greater Glasgow and Clyde request email]

[email address]

 

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FOI BOARD HQ, Greater Glasgow NHS Board

3 Attachments

Dear Mr Keatings

 

Freedom of Information (Scotland) Act 2002

FOI Request: Our ref 13458: Policy on Gastric Bypass Procedures: Response

 

Thank you for your request for information, in your email shown below and
here, asking:

 

If a person has a BMI high enough to warrant a gastric bypass; and if the
person suffers from co-morbidities, specifically type 2 diabetes and sleep
apnoea; and serious disability prevents the person from obtaining a 5%
weight loss (or weight loss target required by NHS Glasgow);Would NHS
Glasgow proceed with said surgery?

 

We are treating your request under our procedures for responding to
requests under the Freedom of Information (Scotland) Act 2002 (FOISA) and
I am now in a position to respond to you on behalf of NHS Greater Glasgow
and Clyde (NHSGGC). You may know that FOISA deals with ‘recorded
information’, that is, official guidelines and protocols, or information
held in minutes from meetings. It does not cover general, unrecorded,
advice or opinions. As such, under this legislation we are unable to
provide you with much information in response to your specific request,
other than the National Planning Forum document which is described below,
and attached. The particular information you request is not recorded by us
and, under Section 17 of FOISA I am required to inform you that NHSGGC
does not record this information.

 

However, we are able to provide you with the following information by way
of explanation and hope this is helpful.

 

We follow national guidance and clinical guidelines in best practice on
managing obesity and in line with National Planning Forum recommendations
surgical intervention is one of a range of treatment options for obese
patients. 

 

The age range for surgery is 18 - 60 years of age, inclusive, for patients
with a BMI of more than 35 and with one or more severe co-morbidities,
principally Type 2 diabetes.

 

NHSGGC is progressing this surgery as a new procedure and selection of
patients for it will be based on a clinical assessment of the patient.  It
is difficult to generalise, however neither Type 2 diabetes, as mentioned
above, nor sleep apnoea would preclude a patient from being considered.

 

Key to patient progression for this type of radical, elective surgery
would be their clinical condition, their co-morbidities, medical
assessment of the patient for surgery and anaesthetic assessment for
operative care; also compliance with lifestyle change and recognition of
the impact this surgical procedure would have on them going forward.
Therefore, decisions to proceed would be based on a variety of carefully
considered factors.

 

A weight-loss in advance of surgery can demonstrate compliance with a
pre-surgery diet, however this would not be the only factor considered in
relation to patients being progressed to gastric bypass surgery as
outlined above.

 

NHSGGC is following the National Planning Forum (NPF) guidance of 2012
in our patient selection for bariatric surgery. This document is publicly
available on the Scottish Government’s website at:
 [1]http://www.gov.scot/Resource/0039/003976...  For your information
we have attached a copy but the guidance includes the following:

 

The gateway criteria for consideration of access to Tier 4 services are
shown below. (Tier 4 are the surgical services)

 

Priority group 1

Individuals who are aged between 18-44 with a BMI 35-40 kg/m2 and recent
(less than 5 years) onset of Type 2 diabetes

Completion of Tier 3 intervention of at least 6 months duration with local
programme compliance and completion of required activities e.g. food
diaries

Weight maintenance with additional weight loss of 5kg where possible

Glycaemic control – HBA1c maintained at <9% on completion of Tier 3 and
supportive behaviour change compliance including achievement of locally
agreed behavioural goals

No contraindication to surgery identified

 

Priority group 2

Subject to all Priority 1 patients being offered treatment and local Board
agreement, individuals who are aged between 18-44 with a BMI of 40-50
kg/m2 and onset of Type 2 diabetes of < 5 years

Completion of Tier 3 intervention of at least 6 months duration with local
programme compliance and completion of required activities e.g. food
diaries

Weight maintenance with additional weight loss of 5kg where possible

Glycaemic control – HBA1c maintained at <9% on completion of Tier 3 and
supportive behaviour change compliance including achievement of locally
agreed behavioural goals

No contraindication to surgery identified

 

Individual reviews

Assessment of patients who do not fulfil the criteria agreed by NPF
through the use of local Board review panels for individual cases

Completion of Tier 3 intervention of at least 6 months duration with local
programme compliance and completion of required activities e.g. food
diaries

Weight maintenance with additional weight loss of 5kg where possible

 

Weight loss during a period in weight management services is a desirable
pre-operation factor, but not the only factor.

 

If you require any clarification about this letter please contact us in
the first instance.

 

If you are not satisfied with our response to your request, you have a
right to request a review of this decision within 40 working days of
receiving this response.  The procedure for consideration of a review is
detailed in the attached note. The note also describes your right to
pursue the matter with the Scottish Information Commissioner if, following
a request for review, you remain dissatisfied with the decision of NHS
Greater Glasgow and Clyde.  If following appeal to the Scottish
Information Commissioner you still remain dissatisfied with the outcome,
you have a right of appeal to the Court of Session on a point of law
against the decision of the Scottish Information Commissioner. 

 

If you wish us to review this decision, please complete the form enclosed
and return it to the Head of Administration, NHS Greater Glasgow and
Clyde, Corporate HQ, JB Russell House, Gartnavel Royal Hospital, 1055
Great Western Road, Glasgow G12 0XH.

 

Yours sincerely,

Kay Dougans

 

Freedom of Information Officer

NHS Greater Glasgow and Clyde

Corporate HQ

J B Russell House

Gartnavel Royal Hospital Campus

1055 Great Western Road

Glasgow G12 0XH

 

[2][NHS Greater Glasgow and Clyde request email]

 

[3][email address]

 

From: Dougans, Kay On Behalf Of FOI BOARD HQ
Sent: 04 January 2018 09:54
To: '[FOI #454912 email]'
Subject: FOI Request: Our ref 13458: Policy on Gastric Bypass Procedures:
Acknowledgement

 

Dear Mr Keatings

 

Freedom of Information (Scotland) Act 2002

FOI Request: Our ref 13458: Policy on Gastric Bypass Procedures:
Acknowledgement

 

We refer to your request for information, shown below in your email.

 

We are dealing with it under our procedures for responding to requests for
information under the Freedom of Information (Scotland) Act 2002 and will
endeavour to reply to you within 20 working days.  If you wish to know how
matters are proceeding with your request, please do not hesitate to
contact us quoting our reference 13458.

 

Yours sincerely,

Kay Dougans

 

Freedom of Information Officer

NHS Greater Glasgow and Clyde

Corporate HQ

J B Russell House

Gartnavel Royal Hospital Campus

1055 Great Western Road

Glasgow G12 0XH

 

[4][NHS Greater Glasgow and Clyde request email]

[5][email address]

 

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