Patients denied vital operations by NHS bodies, surgeons report

http://www.theguardian.com/society/2014/jul/15/patients-denied-operations-nhs-surgeons-report

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Patients are being denied access to vital surgery by NHS bodies, which are ignoring guidelines and choosing to ration some operations, according to an investigation by the Royal College of Surgeons.

The surgeon's report said that 73% of Clinical Commissioning Groups (CCGs) –the GP-led organisations involved in the delivery of a range of NHS services – do not follow rules set down by the National Institute for Health and Care Excellence and clinical guidance on referral for hip replacements, or have no policy in place for this procedure.

It also found that more than a third of CCGs (44%) require patients to be in various degrees of pain and immobility – with no consistency applied across the country – or to lose weight before surgery.

Clare Marx, president of the Royal College of Surgeons, said: "This report seems to show that local commissioners are imposing arbitrary rules governing access to some routine surgery.

"The motivation may not be financial but it is clear that some CCGs do not commission services using clinically accepted evidence-based guidance."

The report, Is Access to Surgery A Postcode Lottery?, analysed information obtained under the Freedom of Information Act and looked at tonsillectomy, hip replacement, inguinal hernia repair and surgical treatment for glue ear (Otitis media with effusion). Only 27% of CCGs reviewed were found to have had policies that complied with Nice or surgical guidance on inguinal hernia repair, while 58% have no policy at all. As many as 15% required evidence of a hernia increasing in size or a history of reoccurring problems, even if a patient is in debilitating pain.

Responding to the report, the body representing CCGs said that they were clinically led organisations that make clinically led decisions centred on the needs of their patients and local populations.

"To insinuate that their motivation is purely financial is wrong," said Dr Steve Kell, co-chair of NHS Clinical Commissioners (NHSCC). "There must be a balance between local decision making and national guidelines and NHSCC will be working with Nice and others to make sure that happens. In my CCG, for example, we have designed best practice guides with the local consultants to improve primary and secondary care management which replaced the old system where patients needed prior authorisation. This kind of locally designed work is going on right across the country."

Dr Amanda Doyle, co-chair of NHSCC, added "Ensuring patients get the best possible care against a backdrop of increasingly squeezed finances is one of the biggest issues CCGs face, but we know that clinical commissioners are already working hard to improve local services by making responsible, clinically led decisions in partnership with GPs, patients and providers."

"Asking patients to lose weight before having hip operations is about reducing the clinical risk to the patient and improving the chance of a successful operations, it is not about money. Tonsillectomy, although one of the most common procedures still carries risks to the patient – the watch and wait approach means clinicians can assess the severity and frequency of attacks to ensure the benefit of having an operation outweighs the risks to the patient."

The report was seized upon by the Labour party, which sought to link its findings to the government's NHS reorganisation.

Andy Burnham MP, Labour's Shadow Health Secretary, said: "Labour always warned that David Cameron's re-organisation would be an attack on the 'N' in 'NHS' and lead to a postcode lottery running riot. This is precisely what has happened."

"Patients should not be waiting in pain and discomfort for operations that are freely available elsewhere. Ministers promised to rule out arbitrary rationing and they can't run from this promise anymore."

The Royal College of Surgeons recommended that the Government and NHS England need to review what further action is required to ensure the NHS is providing equitable access to high quality surgical care.