NHS patients face 'postcode lottery' of surgery referrals

Rates of routine ops vary hugely across country

Rates of routine operations such as hip and knee procedures are four times higher in some parts of the county than others, suggests a new report.

The King's Fund has identified "persistent and widespread variations" in NHS treatment across England, which suggests that some patients are not being given surgery they need while others may be undergoing operations that do not benefit them. 

Researchers found that, in 2009/10, rates of coronary artery bypass grafts varied from 34 per 100,000 patients in Westminster to 197 per 100,000 in Berkshire. Surgery rates for cataract replacement – one of the most commonly performed operations in the NHS – varied by 300% between some areas.

Researchers also found that patients from more deprived areas were less likely to have hip replacements compared to patients from more affluent areas.

The report notes that variation in treatment offered for the same conditions can be justifiable, for example, where patients have opted to undergo a specific treatment rather than to take other options.

John Appleby, chief economist at The King’s Fund said: "This report confirms research over decades, both in the UK and internationally, which has shown persistent and unwarranted variations in use of and access to even the most common surgical procedures. This is unfair to patients and inefficient for the NHS. Remedying this is urgent given the need to improve quality of care while the NHS grapples with the biggest financial challenge in its history.

"The key to reducing 'bad' variation and encouraging 'good' variation is to engage patients in key decisions about their treatment by supporting them in understanding the risks and benefits of treatment, in relation to their own attitudes to their health."

Variation in referral patterns and treatment pathways is not limited to the NHS. Alliance Surgical, the UK's largest group of consultants, has pioneered the use of protocols to standardise the treatment of private patients and avoid over-intervention and believes that this can save insurers and private patients significant amounts of money.

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