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Lives at risk due to arbitrary postcode lottery health rationing warn surgeons

NHS rationing of common operations is putting patients’ lives at risk by subjecting them to “unproven and arbitrary” decicions about their healthcare, the heads of Britain’s top surgical organisations warn.Lives at risk due to arbitrary postcode lottery health rationing warn surgeonsWriting in The Daily Telegraph, the five say decisions over whether patients get operations like hernia repairs, hip and knee replacements, and weight loss procedures are being “compromised by financial pressure”.

Their letter comes after an in-depth study found nine in 10 primary care trusts (PCTs) in England are rationing access to common operations.

Almost two thirds are restricting joint replacements after referral by a specialist, while a similar proportion are doing so for cataracts removals.

Professor Norman Williams, president of the Royal College of Surgeons, and the letter’s lead signatory, said restricting access was nothing but “a quick fix” for financially-strapped health authorities, that would cost more in the long term.

The authors of the letter, who also include the presidents of the British Orthopaedic Association (BOA) and the Association of Surgeons of Great Britain and Ireland, write that access to treatment “should be driven by need based on clinical assessment, and must not be compromised by financial pressure”.

They go on: “Most methods to restrict access to surgery use unproven and arbitrary thresholds which unfairly deny patients some of the most successful operations which vastly improve quality of life.”

Patients are being left immobile when hip and knee replacements are delayed, they say, while hernias are being left dangerously untreated.

“Any hernia left untreated puts the patient at serious risk should the hernia strangulate, meaning that they would require emergency surgery to address the potentially life-threatening problem,” they warn.

Last night (Wednesday), Prof Williams, a colorectal surgeon, said: “Trusts might say, ‘These are the hernia patients we will admit straight away’. But you don’t know which patients are going to strangulate and obstruct the bowel.”

He said he knew of a patient who had been left in severe pain with gallstones, only to be told after being approved for an operation that she had to endure another such painful episode before qualifying.

Different PCTs were setting different criteria for access to operations: “There’s so much variation, which is of considerable concern – we are after all the National Health Service.”

He continued: “We have been worried about restricted access for some time, but it seems to be getting worse.”

He believed health managers were trying to save money, both due to the tighter budget settlement and the demand by Sir David Nicholson, chief executive of the NHS, to make “efficiency savings” of up to £20 billion over four years.

But he said: “Surgery is an easy target, but I don’t think it’s going to save the money they think it will. It is a quick-fix, short term-ism.”

Joe Dias, president of the BOA, said patients needing hip and knee replacements gained less benefit from surgery if made to wait, as the delay resulted in further joint deterioration.

He said patients were regularly being denied surgery, even if they had serious trouble climbing stairs and often woke at night in pain, by trusts relying on a questionnaire called the Oxford hip and knee score.

“We should not make a judgement based on a score,” he said. “We should talk to the patient and see what they can and can’t do.  If the decision to operate is just based on a score, why have doctors?”

Other procedures, including operations to relieve carpal tunnel syndrome, shoulder and ankle problems, and back pain were also being rationed, he said.