Data shows mixed results in reducing 'low value' treatments

In recent years primary care trusts have sought to limit the amount of money they spend on procedures which were supposedly “of low clinical value”.

Exclusive analysis for HSJ by Dr Foster Intelligence looked at activity from 2006 to 2010 for 10 procedures often targeted for reductions.

The data shows that across the procedures as a whole activity has risen over the period, but growth has recently been curtailed in some areas. In most areas activity went up across the procedures, but 14 PCTs reduced activity in the treatments by more than 10 per cent.

Activity fell for some diagnostic gynaecological procedures and tonsillectomies, which were described as “relatively ineffective” by an Audit Commission report in April.

Dilation and curettage or hysteroscopy procedures fell by 12 per cent from 2006 to 2010, while the number of tonsillectomies fell from 46,000 to 41,000. But grommet procedures have not reduced.

Slight reductions and small increases were seen in varicose vein procedures and small increases occurred in hernia procedures – both classed as “potentially cosmetic” by the Audit Commission. Varicose vein operations fell by 4 per cent and inguinal, umbilical and femoral hernias rose by 3 per cent.

However, activity in operations described as “effective interventions with a close benefit or risk balance in mild cases” continued to rise from 2006. Hip and knee replacements have both risen over 30 per cent.

There is also variation in activity between the 2009 and 2010 calendar years, when many quality, innovation, productivity and prevention plans included lists of procedures to be restricted. In some regions activity across the procedures fell, but London and parts of the North West and West Midlands showed rises.

QIPP right care lead at the Department of Health Sir Muir Gray said: “The key issue is ensuring we maximise value, not necessarily reduce the number of operations.” He said this included maximising the “value for the individual by ensuring they know all the options” before treatment.

• Interrogate the data