State planning to restrict access to surgical treatment

Access to common procedures such as cataract surgery and varicose vein treatment is to be restricted under proposals from the State’s health watchdog.

The Health Information and Quality Authority has published a series of reports which propose specific thresholds to be met before a patient could avail of treatment for certain conditions in the hospital system.

Waiting lists

The proposals, which were drawn up at the behest of the HSE, would radically reduce waiting lists. However, they may be interpreted as an attempt to massage the HSE’s performance figures. Last year, almost 50,000 patients were on waiting lists for elective procedures.

The authority says an ageing population, improved but more expensive treatments and lifestyle changes such as obesity are all driving increased demand for services. As a result, the demand for surgery, which grew 22 per cent in 2011, exceeds capacity.

Under the proposals, patients with cataracts would not be referred if they were coping with glasses, while people with tonsillitis would have to show they regularly suffer sore throats before being considered for surgery. About 9,500 cataract surgeries are carried out each year at a cost of €17.6 million. However, the authority says the presence of a cataract does not in itself indicate a need for surgery.

Patients should not be referred for surgery if they don’t want it, or their quality of life is not compromised or where glasses provide “functional vision satisfactory to the patient”. Patients would also not be referred in cases where they have another eye disease which was unlikely to improve.

Cost of treatments

Last year, 2,800 varicose vein procedures were performed but almost 1,000 were on a waiting list. The estimated cost of treatments is about €8.5 million. The authority says patients with no visible or palpable signs of the disease or patients seeking treatment for primarily cosmetic reasons should not be routinely referred for treatment.

It says other countries which have restricted access to surgery have seen a decrease in the number of procedures carried out, a reduction in waiting lists and an increase in the average age of treated patients.

Tonsillectomies

“However, the degree to which these results are relevant or transferrable to the Irish setting is unclear.”

Some 3,500 tonsillectomies are carried out each year at a cost of €10.3 million, but the authority says this includes patients whose symptoms would resolve themselves over time.

Henceforth, patients would be referred only if they had experienced at least seven episodes of tonsillitis in the preceding year, or five in each of the two preceding years, or three in each of the preceding three years. The authority says this referral threshold is not new and is currently being used by many practitioners, but irregularly.

Some 2,800 children have grommets inserted each year to deal with hearing problems at a cost of €4.2 million, but the authority says intervention should not be considered before hearing loss is confirmed over a three-month period. It says children should not have their adenoids removed “in the absence of persistent and/or frequent upper respiratory tract symptoms”.

However, it admits these referral thresholds may be difficult to implement because of a shortage of specialists to test children’s hearing. The proposals are subject to consultation and will be followed by further assessments of other common procedures.

In Surgery Treatments & costs

Cataract surgeries

€17.6m

9,500 carried out each year

Varicose veins

€8.5m

2,800 procedures

Tonsillectomies

€10.3m

3,500

Grommets

€4.2m

2,800 procedures