Variation in surgery rates hints at savings potential

The report, published today, says unjustified variation wastes resources and must be addressed urgently “as NHS funding growth all but stalls over the next four years”.

Variations in Health Care: the good, the bad and the inexplicable says the variation in procedure rates suggests “many patients are not being given surgery they need and that some may be undergoing operations they do not benefit from”. Adjustments have been made for need, based on age and gender.

The King’s Fund found evidence that more deprived patients are less likely to undergo procedures for which there is good evidence – such as hip and knee replacements – but more likely to undergo those less likely to be justified, like tonsil removal.

The report highlights significant variation in uptake of cheaper surgery methods. For example, day case treatment – as opposed to overnight stays – for varicose veins account for as much as 90 per cent of such operations in some primary care trusts and as little as 30 per cent in others.

The King’s Fund recommends greater collection and publication of data about variation, and work to identify the most problematic areas. Once these are identified, it says, “local health organisations – both providers of care and commissioners – [should be] required to publicly justify and explain in a consistent way their relative position on key aspects of healthcare variation”.

It also advocates shared decision making “to establish the right level of variation based on patients’ own assessments of needs and risk aversion”.

King’s Fund chief economist and lead report author John Appleby said: “Remedying this is urgent given the need to improve quality of care while the NHS also grapples with the biggest productivity 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.”

Also published today, an Audit Commission briefing suggests the NHS could save up to £500m a year by reducing ineffective or inefficient treatments.

The figure is based on savings made in some areas by reducing procedures considered to be relatively ineffective or those where there are better value alternatives. It also looked at procedures with limited benefit for mild cases, such as wisdom tooth extraction and “potentially cosmetic” procedures like orthodontics.

The document, Reducing Expenditure on Low Clinical Value Treatments, also calls for “a single approach to defining these low value treatments”, which it says could “reduce duplication of effort between PCTs and help ensure consistency across the country”.