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'Wide variation' in routine ops

Patients in some parts of England are unfairly denied routine operations, while those in other parts of the country are undergoing unnecessary surgery, a report has suggested.

The study by The King's Fund found "persistent and widespread variations" across England in patients' chances of undergoing surgery for the most common procedures such as cataract or hip replacements.

The charity found the differences remained even after legitimate factors such as variation in need were taken into account. "This suggests that many patients are not being given surgery they need and that some may be undergoing operations they do not benefit from," its report said.

Patients in deprived areas appeared to miss out disproportionately on some effective treatments such as hip replacements.

John Appleby, chief economist at The King's Fund, said: "Remedying this is urgent, given the need to improve quality of care while the NHS grapples with the biggest financial challenge in its history."

Rates of patient admissions for hip and knee replacement varied by as much as 400% between some primary care trusts (PCTs). Those in more deprived areas were less likely to have hip replacement surgery than those in more affluent areas, despite evidence that people in deprived areas suffered from poorer health.

Surgery rates for cataract replacement, one of the most commonly performed operations in the NHS, varied by 300% between some PCTs. Operations whose effectiveness has been called into doubt were carried out far more frequently in some PCTs than others, suggesting patients may have undergone unnecessary surgery.

The report said: "The removal of tonsils in children has been queried since the 1930s, yet the rate of tonsillectomies in Coventry PCT in 2009/10 was 10 times higher than the rate in Kingston PCT."

Other examples of variation included rates of coronary artery bypass grafts, which were 34 per 100,000 population in the Westminster PCT area but 197 per 100,000 in the Berkshire PCT area.

NHS Medical Director Sir Bruce Keogh said: "Making this information available to commissioners and patients will help them identify and address unwarranted variation to better meet the needs of their local populations."

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