Hertfordshire health bosses admit they can't afford operations

2:09pm Friday 19th March 2010

By Alex Lewis

HEALTH chiefs admit they have been forced to scrap nearly 50 Hertfordshire operations by financial pressures, but insist their policy is in the best interests of patients.

Since mid-November, NHS Hertfordshire, as the merged primary care trust is now known, has insisted that all GPs, consultants and junior hospital doctors ask for trust approval before performing certain types of operation.

The operations, mostly comparatively minor procedures, are approved only after the trust has reviewed patients' symptoms and circumstances against set criteria, and whether alternative treatments have been considered.

In January and February, 44 applications for operations in Hertfordshire were refused, including the case of retired St Albans vicar Roy Day, and 11 other similar inguinal hernias.

The Reverend Day, whose case was reported by the Review last week, fell foul of the new system because his doctor's application understated the pain he was in.

His groin hernia fell under the new system because it occurs above the hip and, unlike other types, is very unlikely to cause him serious harm.

Director of public health Jane Halpin told the Review: "With anything liked a melanoma, any form of cancer or a cardiac problem, there is no way we would want it delayed - the doctors should just get on and do the op straight away.

"But the number of operations performed has been creeping up and up. Unfortunately it all has a cost. The minimum for a very simple operation is at least £1,000.

"In recent years we have got used to year-on year funding increases, and we know, no matter who wins the General Election, it can't continue.

"We need to get the level of operations back to where it was a couple of years ago. If we don't we are likely to be forced to make some even more unpleasant decisions in the near future."

Besides inguinal hernias, the new system covers tonsil removal, "grommet"operations on the middle ear to improve hearing, cosmetic procedures, hip replacements and cataracts.

Dr Halpin stressed that in many cases the trust is able to approve the operations as the benefit to the patient is clear.

She said: "In some cases a patient can have a cataract which has no impact on vision at all.

"With hip replacements, we have to ask whether it's just someone getting a twinge on the last hole of the golf course, when there are other people with arthritis who can't walk at all."

While the new procedure is mainly motivated by cost pressures, she said there can be sound clinical reasons to refuse an operation.

She said: "Any operation carries risk - a clinical risk as well as a financial risk.

"We have to consider whether an alternative treatment might be more appropriate, or whether the time is not yet right for an operation."