Banbury campaign group objects to plan to axe ops

Dr Peter Fisher (second left) and the KTHG legal team
Dr Peter Fisher (second left) and the KTHG legal team

Banbury campaign group Keep the Horton General has come out against the ending of some routine operations.

The group says forbidding operations that have brought relief to many is a slippery slope.

MHBG-13-06-13 Peter Fisher''Peter Fisher'Dr Peter Fisher'Headshot ENGNNL00120131118164643

MHBG-13-06-13 Peter Fisher''Peter Fisher'Dr Peter Fisher'Headshot ENGNNL00120131118164643

NHS England says the move will save £203.3m. They are consulting on a plan to ban operations to treat snoring, heavy periods, arthritic knees, low back pain, breast reduction, glue ear, tonsilectomies, carpal tunnel release, haemorrhoids, Dupuytren’s contracture release and varicose veins unless the condition is exceptional.

KTHG says the restrictions will force people to go private or enforce continued suffering, impacting on patients’ lifestyles and ability to work.

KTHG’s Dr Peter Fisher said: “To suggest any of these procedures carry significant risk except in a very small minority of cases is alarmist.

“NHS England states the operations should only be carried out if certain conditions are met but they do not say what the conditions are. This will be enforced by financial penalties.

“Patients’ needs are best judged by their GP and specialist, taking into account each patient’s circumstances.

“What is proposed appears a very cumbersome system in which bureaucracy trumps clinical judgment.

“There is reference to consultation but as the list has already been published it looks like the all too familiar ‘consultation’ after the main decision has been taken. The consultation document is 108 pages long and far from accessible to the general reader,” said the retired Horton consultant.

“It is clearly a cost-saving measure, although the amount of time spent working it up must have been expensive. There are much better and more equitable ways of cutting costs, in particular by abandoning the vast expense of the market system.”

Dr Fisher said it was importan to know if similar restrictions will apply to the private sector. He said some years ago he had been forced to go private for an operation featured on a similar list, to correct a potentially serious condition which both his GP and a surgeon advised needed surgery.

“I was not allowed it - or even an outpatient consultation - because it was on the ‘Lavender (rationing) List’ of the local commissioning body. Knowing the risks of doing nothing I had no option but to pay for it. I fear the same will happen to many other people if this plan goes ahead.”

He warned that NHSE plans more exclusions next year.

“We may be at the beginning of an ongoing process of reducing the scope of the NHS. Not a good omen as we celebrate its 70th birthday.”

KTHG’s Sophie Hammond said: “I think it’s absolutely shameful the way it’s been reported with headlines about ‘boob jobs’ and snoring ops, meaning many won’t even have read the articles because they’ll think it only relates to unnecessary procedures.

“Are we consigning people whose hands have painful contracture or women whose menstrual bleeding is so heavy it is making their life a misery, to these inhumane privations?

“Many of these have not been superseded by anything more advanced and don’t seem unnecessary or ineffective. It’s another way of stripping our NHS until it’s more befitting of a developing country, not the fifth richest in the world.”

Ken Hopkins of KTHG said: “What medical procedures were good for you yesterday are good for you tomorrow, unless they have been advanced by science and technology.”

The ops that will be stopped are below with a brief description of NHSE’s alternatives:

• Snoring - alternatives include lifestyle changes (weight loss, smoking cessation and reducing alcohol intake) and medical treatment of nasal congestion

• D&C and Hysterectomy (for heavy menstrual bleeding) - Medication and intrauterine devices as well as weight loss (if appropriates

• Knee arthroscopy washout - physiotherapy, exercise programmes, losing weight (if necessary) and managing pain

• Injections for nonspecific low back pain without sciatica - pain management and physiotherapy

• Breast reduction - professionally fitted bra, losing weight (if necessary), managing pain and physiotherapy often work well to help with symptoms like back pain from large breasts

• Removal of benign skin lesions - no alternative

• Grommets for Glue Ear in children - only for those with at least 3 months bilateral, hearing loss. Hearing aids can as an alternative to surgery

• Tonsillectomy - no alternative

• Haemorrhoids - Eating more fibre and drinking more water. Clinic yreatments like ubber band ligation

• Chalazia (stye cysts) - warm compresses, drops or ointment, steroid injection or ‘watch and wait’

• Arthroscopic shoulder decompression for subacromial shoulder pain - exercise and physiotherapy

• Carpal tunnel - splinting at night, pain relief and corticosteroid injection

• Dupuytren’s contracture release - Physiotherapy and splinting

• Ganglion excision - no alternative

• Trigger finger release - steroid injection

• Varicose veins - endothermal ablation (radio wave therapy) or foam therapy.

For full detail and consultation paper see page 13 - 14 at https://www.england.nhs.uk/wp-content/uploads/2018/06/04-b-pb-04-07-2018-ebi-consultation-document.pdf