HSE to restrict 20 most common surgeries

Access to some of Ireland’s most common hospital surgeries could be drastically cut in a HSE bid to reroute funds for lifesaving services with chronic waiting lists.

The move could limit access to 20 procedures — including hip replacements — as early as 2014. The list, to be finalised, will also include some cosmetic surgery, tonsillectomies, the removal of skin lesions, and varicose vein procedures.

Access to the surgeries could be limited to those with clear clinical need. Up to 50,000 people on waiting lists could be affected, facing the prospect of going private at substantial cost.

State watchdog the Health Information Quality Authority was asked to review the proposal by HSE management in October.

It was asked to focus on whether the system’s dwindling funds could be put to better use elsewhere to help cut chronic waiting lists for more serious, lifesaving surgeries. It will make a recommendation next year.

The HSE believes the move would benefit people in most need.

Fianna Fáil health spokesman Billy Kelleher said it was a sign of the system’s financial problems.

“This is a decision undermining a fundamental principle of healthcare. A patient’s doctor should be the one making the decision.

“People who could be affected may not be facing a life-threatening issue, but they are facing life-changing and quality of life issues.

“This is a Government passing on the responsibility of bad news to some other organisation.”

Hiqa is due to examine if the surgeries are providing enough clinical benefit to the patient to justify continuing existing funding and staffing levels. It will examine whether the existing funds and manpower could be used better elsewhere. If this is proven to be the case, criteria will be given to GPs preventing them from sending most patients forward for these procedures.

For hip replacements, this would include the pain the person is in, their age, and whether the surgery would make enough difference to their life to justify the cost.

Hiqa’s director of health technology assessment, Dr Máirin Ryan, said the first six surgery value checks will be completed by March. The remainder will be finished by Dec 2013, before a recommendation is put to the HSE. This is likely to play a key role in the system’s service plan for 2014.

“Demand for scheduled surgery continues to exceed available capacity, with the HSE reporting a 22% increase in demand for these procedures in 2011 compared to 2010. As a result, pressure on national waiting lists continues to grow despite increases in activity.

“By limiting such procedures in patients who may derive limited clinical benefit, there is a potential to free-up capacity for treatments of higher clinical value, thus maximising population health gain from the limited resources,” she said.

Hiqa has previously been asked to advise on similar service funding issues.

It rejected the need for robotic keyhole surgery, deep brain stimulation to help Parkinson’s disease sufferers, and vCJD blood checks, among others, as the cost outweighed the personal benefit of the services.

A 2008 Hiqa report on the HPV vaccine programme to help fight cervical cancer found this would be money well spent, and played a key role in subsequent Government policy.


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