Banning Procedures On NHS – A ‘gamble With Patient Health’

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The BMA demonstrating against the privatisation of the NHS
The BMA demonstrating against the privatisation of the NHS

Banning NHS operations to save money will gamble with patients’ health, the president of the Royal College of Surgeons warned yesterday.

John Black, one of the UK’s most senior medical figures spoke as the government’s health and social care bill for England was made public.

The ‘NHS is gambling with patients’ health by increasingly banning operations for hernias, cataracts and arthritic joints to save money, he said, accusing NHS primary care trusts (PCTs) of pursuing a ‘dangerous’ course by refusing treatment to patients, who will then suffer unnecessary pain and have less chance of recovering fully.

Increasing numbers of trusts are postponing or axing provision of dozens of elective surgical procedures, including those for gallstones and tonsil and adenoid problems.

The NHS Confederation – backed by the British Medical Association and the royal medical colleges have issued a strong warning that healthcare would suffer as a result of the government ‘reforms’.

Separately, six health unions, including the British Medical Association and the Royal College of Nursing, expressed ‘extreme concerns’ about plans to create greater commercial competition between the NHS and private companies within the health service.

The speed and scale of the reforms proposed by Andrew Lansley, the health secretary, risks undermining the care of patients by putting cost before quality, the unions say.

Black expressed his serious concerns that ‘the immediate need to save money by going for the soft targets of elective surgery would leave a lot of people with unpleasant symptoms and build up future health problems.

‘Medically that makes no sense.’

‘More and more NHS trusts are introducing more and more of this sort of backdoor rationing by imposing longer and longer waiting times for surgery on patients, or indeed stopping doing certain procedures altogether.

‘This is a dangerous path for the NHS to be adopting, because of the long-term health problems that will inevitably be built up if operations designed to prevent long-term harm are delayed or stopped,’ said Black.

‘By reducing elective surgery you can immediately save money, but at the cost of pain, reduced quality of life and deterioration of health.

‘If the NHS continues to save money in this way, we will pay later in terms of future suffering of patients.

’Those denied a new hip or knee to replace one affected by arthritis would have reduced mobility and less independence, for example.

‘Tens of thousands of patients every year are turned from cripples into rehabilitated humans on the NHS thanks to them getting a joint replacement at the right time.

‘To restrict access will result in a lot more people having a lot more pain,’ he added. ‘Patients that aren’t operated on won’t see their symptoms go away; they won’t magically get better. Their hip or knee will just degenerate.’ Delay means an eventual operation is less likely to succeed, he said.

Similarly, men refused a hernia operation could end up developing a strangulated hernia, which requires emergency surgery; and if tonsils are left infected, infection can spread to the middle ear or brain, Black added. Untreated gallstones can lead to complications that can reduce life expectancy.

‘It is unfair of PCTs to decide to leave patients untreated when their condition would until now have been routinely fixed with surgery’, Black said.

‘Increasing restrictions on cataract removals are a complete disaster. With a cataract, you can’t see properly. If there’s an operation to restore people’s sight to normal, most people would consider that to be mainline NHS work that is routinely provided.’

Black criticised PCTs for drawing up lists of procedures they deemed to be of little or no clinical value.

Although cosmetic procedures to remove blemishes were unnecessary, it was ‘odd’ that hip and knee replacements had been placed in the same category.

Evidence showed that new joints were the second most effective health intervention, after giving up smoking, he said.

The NHS in north-east Manchester has just decided to stop providing 57 types of surgery, at least until April. These include new hips and knees, cataracts, hysterectomies to cure heavy menstrual bleeding, ‘trigger finger’, tonsil removals and all aesthetic procedures, such as tattoo removals.

Even surgeries with an 80 per cent success rate have been classified as having ‘no clinical value’.

National NHS bosses made clear that care of patients should not be affected in the quest to save the £20bn.

The Patients Association helpline has received calls from patients whose planned operations had been cancelled without a new date.

‘Why are patients having to suffer in order to balance the books?’ said Katherine Murphy, its chief executive. ‘I would say to the NHS, think again and think hard, don’t make patients the victims of budget cuts and save the money elsewhere.’

•Meanwhile, Swine flu: has gridlocked the NHS. Hospitals across the country have reached the highest level of emergency. Dozens of NHS units have cancelled surgery and clinics for outpatients because of flu and other winter viruses.

At least 10 major centres issued ‘black alerts’ meaning they were at breaking point, forcing patients to be sent elsewhere

Scores of hospital wards closed due to norovirus, the winter vomiting bug, which put more than 1,200 beds out of use in one week as nurses attempted to isolate the disease.

John Heyworth, the president of the College of Emergency Medicine, said: ‘We have seen A&Es absolutely overwhelmed, with people queuing on trolleys and long delays even for those being admitted to intensive care.

He expressed anger about the failure of Government and the NHS to develop sufficient contingency plans, given that a flu outbreak was widely anticipated following the swine flu pandemic in 2009.

‘My frustration is that so much of this is predictable. This did not come out of the blue and yet the planning is inadequate — as though there is a sense of denial about it. The planning this winter has been far less effective than last year.”

Heyworth claimed casualty units had been hit by a ‘dramatic surge’ in demand not just because of an increase in the number of very sick patients suffering flu complications, but also because less serious cases went to A&E because they could not see a GP at evenings or weekends.

Defending the governments position, Professor Bruce Keogh, the NHS’s medical director said, ‘We would not recommend creating definitive lists of ineffective or inefficient procedures without a clear consensus from clinicians who are experts in the field,’ he added.

NHS leaders hope to agree with specialist groups of doctors and surgeons which effective operations the NHS should fund and which ineffective ones should be withdrawn, Keogh added.

‘This provides the opportunity to direct taxpayers’ money towards effective rather than ineffective treatments.’