Hundreds of obese people waiting more than five years for surgery

Report warns of dangers of funding shortfalls at a time of rising levels of obesity

Hundreds of morbidly obese people are being left waiting more than five years for potentially life-changing surgery, a private medical report compiled for Minister for Health Simon Harris has said.

The unpublished document, relating to bariatric services at Galway University Hospital, warns of the dangers of funding shortfalls at a time of rising levels of obesity and related illnesses.

By June about 670 obese patients were facing the delays, with numbers rising all the time.

The report, submitted to the Minister last month, notes there are just over 500 patients awaiting psychological and surgical evaluations for sleeve gastrectomy operations, with both steps required before a patient can undergo the procedure.

“In effect, patients referred for bariatric surgery in Galway remain on a waiting list for surgical and psychological assessment for more than two years,” the report states.

“Moreover, 170 patients have been seen by the surgeon and the psychologist ... and have been placed on the waiting list for surgery. At current rates of surgical activity in Galway, they will be waiting in excess of five years.”

The 78-page report was written for Mr Harris's attention by Dr Francis Finucane, consultant endocrinologist at the hospital.

In an accompanying letter he expressed concern that “critically important resources that we have sought will not be forthcoming. We simply cannot let this happen.”

Sleeve gastrectomy operations remove part of the stomach, reducing food consumption. They are considered a crucial option in tackling chronic obesity, which continues to rise in Ireland.

They are carried out publicly at the Galway hospital and St Vincent’s in Dublin, and privately at clinics in Dublin, Cork and Galway.

Those who undergo the procedure can lose up to 20 per cent of their body weight within a year. The surgery can also result in the discontinuation of treatment for diabetes, a major illness associated with weight gain.

Good procedure

A 2016 paper published in the Irish Journal of Medical Science stated that, in a world where obesity rates have “soared”, gastrectomy is “increasingly regarded as a good surgical procedure”.

The paper put Irish rates of obesity at 22.9 per cent among men and 22.5 per cent among women.

“Despite vigorous efforts, the obesity endemic has continued to rise,” it said, highlighting a correlation in increasing rates of associated illness such as type 2 diabetes, cardiovascular disease and cancer.

In a letter to then minister for health Leo Varadkar in 2015, Dr Finucane highlighted a study suggesting €1 billion of annual public expenditure be channelled towards obesity-related treatment alone.

Last year an article published by the International Federation for the Surgery of Obesity stated that the current rate of bariatric surgery in Ireland falls short of international ethical standards – fewer than one in 100,000 people, compared with 70 in France and Sweden, and 50 in the US.

Despite this the report submitted to Mr Harris is highly critical of funding procedures, with repeated Galway University Hospital appeals “falling on deaf ears” in recent years.

“The process for requesting and prioritising these resources is unclear, opaque and convoluted. The allocation of resources nationally is inequitable, arbitrary and lacks transparency,” it said.

"There was 'token' funding of 15 surgeries through the National Treatment Purchase Fund in 2018, but as we articulated to hospital management at the time, this is wholly inadequate and is symptomatic of systematic de-prioritisation of bariatric services in Galway."

Department response

In response the Department of Health said obesity is a priority issue for the Minister, particularly improving access to hospital treatment, and he has recently met with HSE officials to discuss it.

“The NTPF [National Treatment Purchase Fund] continues to work with Galway University Hospital and this year has provided funding which has enabled the treatment of additional patients under the bariatrics service,” it stated.

“Waiting times are often unacceptably long and place a burden on patients and their families. [However], there are major challenges to health funding.”

A recent report by a Royal College of Physicians in Ireland expert group concluded that the costs of failing to do so were “incalculable”.

“Given the personal suffering experienced by people who are obese, and the rapidly emerging health system costs in treating an extensive and most distressing range of associated complications of [being] overweight, building further capacity in bariatric surgery is both urgent and essential,” it said.

Mark Hilliard

Mark Hilliard

Mark Hilliard is a reporter with The Irish Times