Childhood Obesity in the United Kingdom 113Figure 7. Bariatric surgery in 2009. Courtesy of http://bariatrictimes.com/the-
provision-of-bariatric-surgery-in-the-united-kingdom%E2%80%94past-present-and-
future-considerations-the-road-to-excellence/.
A similar attitude of under-referral has been evident with respect to
childhood surgery. It is believed that this is due in part to the reservations of
some clinicians and families to consider bariatric surgery on children, but also
certain hospital trusts in conjunction with the Clinical Commissioning Groups
(CCGs) – who provide the money and funding for healthcare services
provided by the Trusts- have adopted stricter referral criteria – most likely
with the aim of deterring referrals and ultimately saving money. To help
understand this it is necessary to point out that the majority of bariatric surgery
performed in the UK (adult and paediatric) is publically funded under the
NHS. The NHS is a healthcare system funded through national taxation. It was
established in 1948 with the aim of providing an ideal healthcare system
available to all. Care in the NHS remains free to all UK and European Union
Nationals at the point of delivery. The NHS has grown to become the world’s
largest publicly funded health service, and it the world’s 5th largest employer
after the United States Department of Defence, The People’s Liberation Army
(China), Walmart and MacDonalds (Chinese army, The Indian National
Railway [131]. The CCGs are allocated budgets from the government, and
they procure services for provision of healthcare therefore they have a level of
discretion at how they spend some of these funds. The NHS has been in
financial crisis over the last few years and efficiency savings are high on the