Letter: Patients who are no longer priorities

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Sir: Virginia Bottomley, the Secretary of State for Health, is reported to have said (12 March) that it is for ministers to give strategic directives to the NHS. We acknowledge that to be a difficult task.

During the approach to the last general election, plastic and reconstructive surgeons within the NHS were coaxed and compelled to achieve a politically attractive reduction in the numbers of 'long-waiters' for surgery. These included children deeply disturbed by teasing about prominent ears; women disabled by enormous breasts or hanging aprons of skin resulting from weight loss or pregnancy; adults with severely deformed noses, or even with tattoos that may prevent them from obtaining employment.

We are now puzzled by a strategy, pursued by some purchasing authorities, that disparagingly categorises such conditions as cosmetic and decline to purchase treatment for them. Thus, the group of patients we are being urged to treat now seems proscribed, despite the fact that treatment falls within the Secretary of State's prescription of 'meeting the needs of patients, with good outcome, relating to the quality, of life and representing good value for money'.

We urge Mrs Bottomley to see that a strategy consistent with her aims be enforced on all health authorities and throughout the NHS and that patients' needs, as judged by those entrusted with their care, be the criteria by which prioritisation is made and treatment afforded, rather than arbitrary decisions by health service executives armed only with a diagnosis.

Yours faithfully,



British Association of

Plastic Surgeons

London, WC2

15 March