Routine operations on hit-list

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The Independent Online
Since the inception of the NHS in 1948, new treatments and procedures have been introduced in a piecemeal and haphazard fashion. The rationale for implementation appeared to be "if it is new, it must be better and we must have it".

In fact, it is estimated that less than 15 per cent of health service "interventions" have been proved to be beneficial to patients. It comes as no surprise to learn that in the new cost-conscious, market-style NHS, some of these interventions are to be phased out.

Stephen Dorrell, Secretary of State for Health, declined yesterday to spell out which treatments would be phased out of routine use in NHS hospitals and clinics but it is not difficult to guess what they might be.

John Yates, a former government adviser, has said that of the top 10 operations performed in NHS hospitals, only hernia repair and cataract surgery are widely regarded as sound procedures with a high degree of clinical agreement about who will benefit and when the operations should be done.

The more questionable operations include hysterectomy, tonsillectomy, D&C or womb scrape before the age of 40, and the insertion of grommets to treat glue ear. In the latter case, 80 per cent or more clear up without treatment.

There are some "innovations" that have assumed popularity without adequate investigation of their use or proper training of the people who use them: keyhole surgery is one example. Several patients have suffered long-term internal damage after inappropriate use of keyhole surgery or less than optimum handling of the equipment.

Chorionic villus sampling (CVS) was hailed as a major advance in pre- natal diagnostic testing as doctors were able to perform it weeks earlier than existing tests such amniocentesis. It was widely reported in newspapers and was adopted for routine use prematurely, according to some doctors, as women demanded the test from their obstetricians. Subsequently, a link was established between CVS before 10 weeks and limb defects in babies. Now CVS is performed after 10 weeks.

Obstetrics in general has a reputation for adopting, wholesale, new techniques without good evidence for their benefits. Mass foetal screening - the use of probes attached to the foetal scalp during labour to monitor its status regardless of a problematic delivery or not - is widely believed to have caused more difficulties than it solved. Meanwhile, cheap and proven treatments, such as steroidal drugs to help mature the lungs of babies likely to be born early, went unheeded.

Stephen Dorrell yesterday called time on inefficient, obsolete treatments and those that are expensive and have limited application. They are likely to be replaced with innovations such as gene therapy, designer drugs, robotics in surgery, and more accurate diagnostic tests.

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