Operations halted as rationing row erupts

Berkshire Health Commission yesterday gave the debate about NHS rationing a further twist by agreeing to ban non-essential sex-change operations, tummy tucks and the removal of wisdom teeth that are not causing pain as part of a package aimed at halting a pounds 7m overspend.

In addition, the health authority is planning to reduce the number of operations for varicose veins, grommets and snoring while reducing the number of "D and Cs" - scraping of the lining of the womb - in women under 40.

The commission said all the procedures in the latter category were of "doubtful effectiveness" and there was a national drive to reduce the number performed.

In every case - including tummy tucks, sex-change operations and wisdom teeth - the commission said: "These treatments will still be available where there is a clinical need. There is no absolute ban on their provision."

Last night the commission could not say how much the move would save, or how much it had spent on these procedures last year. The pounds 3.5m package of savings it constructed yesterday towards its pounds 7m deficit included cuts in GP fundholders' budgets, reduced management costs and the redirection of savings made from new contracts for the treatment of Aids and HIV infection.

The decisions produced a furious reaction at a meeting in Maidenhead Town Hall and calls for the Commission's resignation. Its chairman, Richard Eassie, told his audience: "There is no point in moaning about it, we have got to get on with it."

A spokesman defended the package, arguing in the case of grommets, for example, that 95 per cent of cases clear up within a year without treatment, and the operation was of "dubious value". Other procedures that the commission already lists as "low priority" are artificial insemination, reversal of sterilisation, various forms of cosmetic surgery, and residential psychotherapy for substance abuse. But again, if a doctor argues that they are clinically necessary, they are provided.

Alex Carlile, the Liberal Democrat health spokesman, called on the NHS Executive to take the health authority over and run it "until a proper NHS can be restored to the people of Berkshire" while Tessa Jowell, a Labour health spokesman, said the package was "proof that there is no longer a national health service" but rather one where treatment depended on postcodes.

As the row erupted, however, Sir Michael Peckham, Director of Research and Development for the NHS, said hundreds of millions of pounds a year could be saved if existing evidence on which were the best and most cost- effective treatments were applied. Rather than rationing, that implied spending the money on treatments that worked, rather than on those that did not, or worked less well, he said.

One piece of evidence alone about the treatment of women threatening to deliver prematurely could, if applied nationally, not only reduce both morbidity and mortality in babies, but also save about 5 per cent of money spent in neo-natal intensive care.

Bob Abberley, head of health for the public sector union Unison, said the measures were a clear result of government underfunding, and that such rationing was leading to a two-tier NHS. But Philip Hunt, director of the National Association of Health Authorities and Trusts, said the issue should be kept in perspective. "When health authorities are having to restrict services, they tend to be marginal treatments," he said.