Are you a smoker? Are you overweight?
If your doctor thinks you need an operation then you may be given help to stop smoking or reduce your weight before you go to hospital.
From 1st November 2016, patients who are obese or smoke will be asked to spend six months getting fitter before being referred for routine (non-urgent) surgery.
Fitter patients recover more quickly after operations and stay healthier for longer too.
Please read our leaflet for more information. Click here.
Health optimisation before routine surgery
Harrogate and Rural District CCG have approved a range of measures to improve the health and wellbeing of patients. Healthy lifestyle behaviours have a positive effect on your health. Patients who have a BMI of, or greater than, 30 or people who smoke will be offered a referral to either a weight management programme or stop smoking services for a 6 month period of health optimisation before being considered for a non-urgent routine operation.
BMI (body mass index) is a measure of whether you are a healthy weight for your height. For more information on how to calculate your BMI please visit: http://www.nhs.uk/tools/pages/healthyweightcalculator.aspx
We know that patients in good health recover better after an operation and have fewer complications. By taking care of yourself beforehand, you can reduce the risk of complications and help you heal as quickly as possible. Harms caused by smoking and obesity are potentially preventable and referral to support services prior to elective surgery offers an opportunity for you to improve your health and reduce the risks of surgical complications. There are other healthy lifestyle behaviours which are good for your health like being active and reduced alcohol intake.
What are the implications of surgery if I am obese or smoke?
Some of the risks associated with obesity and smoking when undergoing surgery:
- increased risk of deep vein thrombosis (blood clots);
- more difficult to insert a tube into the windpipe for general anaesthesia;
- lower oxygen levels during surgery;
- more difficult to insert needles for regional local anaesthetic injection;
- increased risks of wound infection;
- longer recovery from general anaesthesia.
- increased risk of lung and heart complications;
- increases the time it takes for bones to heal after repair;
- increased breathing problems;
- increased length of stay in hospital.
What does a referral to Weight Management mean?
You can access free support to help you lose weight through Harrogate Borough Council’s ‘Fit4Life’ programme. If you have been referred to weight management before your surgery, there will be a number of benefits for you. The first step will be to have an initial telephone conversation with an instructor to discuss the best option for you based on your medical condition and recommendations from your health professional. You will then be invited to an induction where your current activity levels, diet, past experiences, lifestyle goals and interests will be reviewed and you will be able to find out more about the programme. The weight management service is offered as a 12 week programme that supports you to make positive changes to your diet and increase your physical activity levels. Sessions are held in a wide range of venues, at varied times, across the Harrogate district.
What does a referral to a Stop Smoking Service mean?
You can access free support to help you quit smoking through LivingWell Smokefree. There is a range of support available to suit you, including drop-in clinics, group sessions, online support, telephone support or weekly one-to-one appointments with a free supply of medication, such as Nicotine Replacement Therapy (NRT). If you have problems with mobility and would prefer face-to-face support, home visits are available too. If you are pregnant and would like to quit, you can access the LivingWell Smokefree service below, or your midwife will offer a referral in to the service.
What are the benefits of losing weight and quitting smoking?
Studies show the benefits of losing weight and quitting smoking when undergoing surgery include:
- Decrease the complications most commonly associated with obesity;
- Improvements in metabolic function in many tissues, including fat, liver, and muscle;
- Long-term health benefits, including lowered risk of disease development;
- Losing weight can help in the control and prevention of coronary heart disease, hypertension, type 2 diabetes, hyperlipidaemia, cardiorespiratory failure and other chronic degenerative diseases.
- Having more energy;
- Sleeping better and waking up feeling rested and in a good mood;
- Having fewer aches and pains;
- Improved ability to move and get around;
- Finding it easier to breathe and decreased respiratory issues;
- Improved immune system (ability to fight off illness).
Are there any exclusions to this policy?
The exclusions to needing to complete the 6 month health optimisation period are:
- Any urgent or non-routine procedures
- Patients undergoing surgery for cancer
- Referral for suspicion of cancer
- Patients with a BMI of 30 or greater but who have waist measurement less than 94cm in males or 80cm in females
- Patients with severe mental health illness, Learning Disability or significant cognitive impairment
- Referrals for interventions of a diagnostic nature e.g. endoscopy
- Children under 18 years
- Frail Elderly (as a guide – 3 or more of the following: unintentional weight loss; self-reported exhaustion; weakness (grip strength); slow walking speed; low physical activity)
- If an exclusion applies to you, you will still be given lifestyle advice, however your referral will progress as normal.
If you don’t meet any of the exclusions above but your doctor feels a period of health optimisation may be detrimental to you, you may be considered through the CCG’s Individual Funding Request panel – your doctor will apply on your behalf.
Patients who only use electronic cigarettes will be classified as a non-smoker.
What if I am being referred to the hospital for tests or an opinion rather than an operation?
Patients being referred to surgical specialities for diagnostic test(s) will be advised by their GP that if non-urgent, planned surgery is the outcome after being seen by the hospital, they will still need to complete the 6 month health optimisation period. The hospital will refer you back to your GP for this discussion and for onward referral to take place after the 6 month health optimisation period.
What happens once I have completed my health optimisation period?
At the end of your 6 month Health Optimisation Period or when you have stopped smoking for more than 4 weeks and/or reduced your BMI measurement to under 30, you should make a follow up appointment with your GP to discuss your health and your referral.
What if my health changes during the 6 month health optimisation period?
If you are concerned that your health has deteriorated during the 6 month health optimisation period, you should discuss your concerns with your GP who will reassess the situation.
How do I access the support services?
Referral to the service will be made by your GP, with your consent. Alternatively you may contact the service directly (self-referral).
Tier 2 Weight Management Enquiries:
Telephone 01942 404799
Stop Smoking Service Enquiries:
https://www.northyorks.gov.uk/stopping-smoking - web referral form and information
Telephone LivingWell Smokefree on: 01609 797272
Other lifestyle support services available through self-referral:
Telephone: 01723 330730
Harrogate and Ripon Centres for Voluntary Service have a fully searchable “Where to Turn” Community Directory which gives access information for hundreds of community activities and services to support good health and well-being.
For more information about the NHS in the Harrogate and Rural District area please visit the CCG’s website: http://www.harrogateandruraldistrictccg.nhs.uk/
If you would like this document in a different format or language please contact 01423 799300.