Patients put at ‘unnecessary risk’ as health bodies put restrictions on access to care

Leading surgeons have raised concerns over the rising number of local health bodies restricting a type of curative surgery.

In a new audit of the care of patients in need of a groin hernia repair found that over half of England’s clinical commissioning groups (CCGs) are placing restrictions on access to treatment.

The review found that some CCGs are “placing overly prohibitive and potentially dangerous criteria on accessing surgery”.

Through a series of Freedom of Information requests, the Royal College of Surgeons (RCS) and the British Hernia Society (BHS), found that 57% have policies in place that restrict patient access to curative hernia repair, according to responses from 186 CCGs.

A 2014 RCS audit found that 29% had put some sort of restriction on surgery.

The surgical repair of inguinal hernias is one of the most common to procedures on the NHS, with almost 80,000 carried out annually in the NHS in England, the report states.

The authors said that despite the effectiveness of the surgery, CCGs are “increasingly restricting access to treatment for patients to save money”.

“This has been shown to produce poorer outcomes for patients and can increase the risk of adverse events, including, in rare instances, death,” they wrote.

It found that many organisations had adopted a “watchful waiting” approach, whereby patients need to be suffering from pain or discomfort sufficient to impede everyday activities or working life before surgery is allowed, but the authors highlighted how patients under such hernia management are more likely to need emergency surgery and are a at higher risk of “adverse events” or death.

The authors said they found a “significant increase in the percentage of CCGs encouraging conservative management of inguinal hernias or, in some cases, placing overly prohibitive and potentially dangerous criteria on accessing surgery”.

They added: “These results show significant regional variation in access to surgery, thereby meaning that outcomes are too often dictated by a patient’s postcode and not by the nature of their condition.”

Groin hernias frequently affect more men than women. The condition usually occurs when a weakness in the abdominal wall allows fatty tissue or a part of the bowel to protrude into the inguinal canal.

It can cause pain and if left untreated it can cause severe complications.

Susan Hill, senior vice president of the Royal College of Surgeons, said: “It is an absolute disgrace that some patients have to demonstrate what could be a life-threatening complication of a hernia, which is one of the most straightforward surgical conditions to treat.

“Instead of asking patients to prove their pain, ministers and NHS England should immediately intervene to allow patients to talk to their surgeon about whether they need an operation.

“Allowing commissioning groups, not patients with their surgeon, to make a decision to operate is putting patients at unnecessary risk of serious complications.”

David Sanders, of the British Hernia Society, added: “It is simply not acceptable to justify restrictive criteria as best practice.

“This denies patients access to a procedure that potentially limits pain and improves quality of life.

“The NHS has to be very clear about what it offers.

“Does it want a value for money service with quality and safety as a priority, or a rationed service that will inevitably put some patients at risk?”

Commenting on the report, Jonathan Ashworth, Labour’s shadow health secretary, said: “Yet again we see more evidence of crucial treatments being rationed at a local level.

“Not only is this policy building up further financial pressures on the acute sector but asking men to wait longer and longer in pain and at serious risk of further complications is totally unacceptable.

“The new Health Secretary must urgently intervene otherwise he will have failed thousands of patients currently denied the surgery they need.”

A Department of Health and Social Care spokesman said: “Decisions about when or whether a patient should have an operation are rightly made by clinicians based on the patient’s need.

“However, blanket restrictions on treatments are unacceptable and we expect NHS England to intervene if there is evidence of rationing care.”

NHS England said that NHS Clinical Commissioners would be commenting on the analysis.

Dr Amanda Doyle, co-chair of the membership organisation of clinical commissioning groups, said: “CCGs are led by GPs whose first priority is always to the patient.

“Wherever possible they want to give them what they need, including surgery to repair groin hernias. In cases where there is a high risk of complications or where patients are in persistent pain as a result of groin hernias, most CCGs will commission surgery.

“Unfortunately the NHS does not have unlimited resources and ensuring patients get the best possible care against a backdrop of spiralling demands, competing priorities and increasing financial pressures is one of the biggest issues CCGs face.

“On a daily basis they are forced to make difficult decisions that balance the needs of the individual against those of their entire local population. As a result, there are some tough choices that have to be made, which we appreciate can be difficult for some patients. “

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