Patients experience persistent and widespread variations in the chances of undergoing surgery for common medical conditions on the NHS such as knee and hip replacements, a new study has revealed.
The findings were released the same day as a report suggesting the NHS could save up to £500m a year by carrying out fewer ‘low clinical value treatments' deemed ineffective or inefficient.
Research by The King's Fund suggested many patients were not being given surgery they need and that some may be undergoing operations they do not benefit from.
It found significant variations between primary care trusts (PCTs) in the rates of common operations even after allowing for legitimate factors that affect rates of surgery.
Inparticular, patients from more deprived areas were less likely to have hip replacements - an operation with a strong evidence base for being effective - compared to those from more affluent areas.
This was also characterised by rates of admissions for routine operations such as hip and knee replacement varying by as much as 400% between the highest and lowest PCTs.
John Appleby, chief economist at The King's Fund said: "This report confirms research over decades that has shown persistent and unwarranted variations in use of and access to even the most common surgical procedures.
"This is unfair to patients and inefficient for the NHS. Remedying this is urgent given the need to improve quality of care while the NHS grapples with the biggest financial challenge in its history."
In its report, the Audit Commission suggested a single approach to defining low value treatments could help reduce the duplication of effort between PCTs and help ensure consistency across the country.
The Commission said it is not advocating any particular list, but the types of low value treatments identified in its study of some PCTs included:
• those considered to be relatively ineffective, eg a tonsillectomy;
• those where more cost-effective alternatives are available, eg not performing a hysterectomy in cases of heavy menstrual bleeding;
• those with a close benefit and risk balance in mild cases, eg wisdom teeth extraction; and
• potentially cosmetic procedures, eg orthodontics.
Based on one of the more widely-used lists, some Trusts could save more than £12m a year by reducing their use of these, or other treatments, it added.
Andy McKeon, MD of health at the Audit Commission, said: "Some PCTs have successfully addressed the issue and are now able to spend the money they have saved on more effective treatments."
"Many others are seeking to do something similar. Our report provides practical advice on how best to do this. A single national evidence base would also reduce variation in the treatments available and duplication of effort."
