Doctors ration treatment for heart patients

Annabel Ferriman reports on a points system that could cut waiting lists

DOCTORS IN the Midlands have introduced a radical new method of rationing medical care, which could provide a blueprint for services elsewhere in the country.

While the Health Secretary, Frank Dobson, is pulling out all the stops to reduce waiting lists, many health experts believe that the short-term measures being used, such as extra operating sessions on Saturday mornings, are not the answer to the problem. An increasing number of doctors believe that the NHS needs a proper rationing system.

Now cardiologists at the Glenfield General Hospital, Leicester, have decided to lead the way and bring a degree of objectivity to the task of deciding which patients should receive certain expensive diagnostic tests and which should not. In response to waiting-list pressure, they have introduced a scoring system. Only patients who get 40 points or more receive a particular investigative procedure, known as an angiogram, which costs about pounds 600 and which reveals whether or not a patient has clogged coronary arteries.

The new rationing policy modifies the previous system, whereby patients were simply designated urgent, intermediate or routine.

"We think our scoring system introduces a visible degree of equity and objectivity into the process," said Dr Douglas Skehan, consultant cardiologist. The hospital's cardiology department sees about 2,500 patients annually who might benefit from an angiogram, but only has enough money to carry out 2,000, so a system of prioritising patients is essential. The rationing system saves pounds 300,000 a year, while ensuring the most serious cases are still investigated.

The scoring system, which is based on a scheme worked out in New Zealand, awards points according to the severity of the patient's symptoms, the results of an exercise test and whether he or she has had a previous heart attack, has to take many drugs, has diabetes or cannot work because of the symptoms. It does not apply to urgent patients with unstable angina, who are investigated within days or weeks of admission.

"Patients who receive 40 points or more are investigated by angiogram and if they are found to have serious heart disease they are put on a list either for surgery or for angioplasty [a procedure in which a blockage of the artery is cleared by inflating a small balloon in the blood vessel]," Dr Skehan explained.

"Patients who get less than 40 points are not abandoned. We either follow them up ourselves or liaise with the patients' GPs, so that if their symptoms worsen, they can be brought back and investigated," he added.

The new system, introduced at Glenfield by David de Bono, professor of cardiology, is revealed in the programme The Goldring Audit, to be broadcast on Channel 4 next Sunday and Monday to coincide with the 50th anniversary of the NHS. It examines how one health authority - Leicestershire - spends its money and shows how limited is its room for manoeuvre.

Professionals in the NHS who think that a proper system of rationing should be introduced have set up the Rationing Agenda Group (RAG), which aims to educate the public about the subject. They believe rationing is already here, that we should acknowledge it and bring logic and transparency to it.

The Goldring Audit, Channel 4, 9pm, 29 June