Bid to tackle hospital care ‘lottery’

INEQUALITIES in access to hospital care in Yorkshire could be significantly reduced by new care thresholds targeting long-standing postcode lotteries for common treatments.

The variations mean some people are as much as five times more likely to undergo hospital treatment in some parts of the region than others.

Hospital doctors, GPs and managers have agreed thresholds which standardise eligibility for treatments including hip and knee replacements, cataract and wisdom teeth extractions and tonsillectomies. A range of other procedures including operations to remove gall bladders, angina treatment and hernia repairs are also being included.

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But a key part of the moves also aims to generate savings worth as much as £45m in the region by 2014 by cutting numbers of patients treated in hospital and giving them alternative treatment in the community.

Official figures reveal the biggest inequalities in access affect patients requiring wisdom teeth operations, with five-fold variations in numbers undergoing extractions in hospitals across the region. Access to knee replacements varies by three times depending on where people live.

There are major differences too in other aspects of hospital care. Patients undergoing gall bladder removals are four times more likely to be treated as cheaper day cases in some parts of the region, while rates of day-case surgery for hernia problems ranges from 40 to 80 per cent from hospital to hospital.

Clinical thresholds have so far been introduced piecemeal across the region and early evidence suggests their impact has varied.

In Sheffield, there has been a 12 per cent fall in referrals for planned hip and knee replacements since June, although a pilot scheme in Barnsley last year led to a 20 per cent fall. Those qualifying for operations need to be in moderate-to-severe pain which is not adequately relieved by other treatment and interferes with activities such as washing, dressing and sleeping.

In Rotherham, officials are auditing the impact of thresholds which they expect to deliver savings up to 2015, while managers in Wakefield predict the measures will deliver results shortly after their introduction in September.

In contrast in Leeds, latest figures suggest a slight increase in numbers of procedures carried out despite the new compacts. But in Bradford managers say they have not introduced the thresholds as they do not believe they will achieve further efficiencies.

Health chiefs in northern Lincolnshire say the compacts are similar to measures in place before, while officials in Hull say they have adopted measures to streamline access to gallstone surgery but none of the other compacts are being employed. The guidelines are yet to be adopted in the East Riding but officials say they are “broadly in line with existing clinical practice”.

In North Yorkshire there was a 17 per cent fall in cataract operations carried out between April and October.

But the county has also seen a 26 per cent increase in wisdom teeth extractions over the same period although more are being carried out more cheaply by dentists rather than in hospital.

Officials say they are auditing the impact of new orthopaedic referral guidelines following their introduction earlier this year.

The county’s NHS, which has been beset by financial problems, introduced clinical criteria as early as 2006 to reduce inconsistencies in referrals which it is estimated saved £1m in 2010-11. Further controversial restrictions to hip and knee surgery were introduced in May limiting access to obese patients until they lost weight and to smokers unless they gave up the habit prior to surgery.

A report to hospital chiefs in Scarborough in October said the additional measures were beginning to have some impact although they had been “heavily criticised” by surgeons and had “little support” among GPs.

It went on to claim that alternative proposals to adopt a system using measurements of pain to decide when to operate on patients with joint problems were “unlikely” to be supported by other hospitals in North Yorkshire which intervened “much earlier” than the system suggested was appropriate.

Comment: Page 12.