"The NHS will last as long as there are folk left with the faith to fight for it"
Aneurin Bevan

Monday, 24 October 2011

Cherry picking

The Croydon List is study performed by the London Health Observatory and the Croydon PCT in 200x to determine how much can be saved by not performing cosmetic and ineffectual procedures.

The Croydon List also includes those procedures that have a clinical benefit but are performed when there is a "close benefit/risk balance in mild cases", or to put it in ordinary English, the patient is not yet blind enough, or in enough pain, to benefit from the operation. Let me give you some procedures that are in the ten most common procedures on the Croydon List:

ProcedureMin ReductionMax Reduction
Inguinal hernia25%50%
Varicose veins20%80%

You can see from this that according to the Croydon List varicose veins operations are considered low clinical value (money can be saved by not doing up to 80% of those that are done now) and that savings can be made on the others by not performing "milder" cases.

The reason whey I mention this is because HealthInvestor (a magazine for private sector healthcare) reports a paper in BMJ that says that "patients undergoing surgery in independent sector treatment centres (ISTCs) have slightly better outcomes than patients treated by NHS centres" and HealthInvestor gives the conclusion that these results "lessen concerns that ISTCs are 'cherry picking'".

However, this is exactly what the ISTCs have done because "The study reviewed the outcomes of patients undergoing hip or knee replacement, inguinal hernia repair and treatment for varicose veins across 25 ISTCs and 72 NHS providers in England". That is, they are procedures that the Croydon List says are either of little clinical use, or where cases can be considered not to be severe enough to be treated. If they are on the Croydon List it does show that ISTCs have cherry-picked the easier procedures to perform.

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