I’ll vote for that. Plaid Cymru in single health board pledge… So would many GPs and Consultants

The doctors are more aware than most people how restricting choice affects their health care. As informed potential users many have PMI (Private Medical Insurance) through BUPA and other policies. But the ITV news 8th October was “Plaid in single health board pledge”, would appeal to most doctors and nurses. The rules of the game in Wales are that if a service is available in your own Welsh Health Trust, then you cannot choose to have it in another trust. This is in direct contrast with England. It might be a reasonable method of covert rationing, but most medics do not think so. what they think probably also applies to their patients. As a group population local people will vote to retain every service they have had, but as individuals they will exercise choice if they are given it. We are not all sheep..

In an article in the Times (body and soul 24th November 2015 – Dr Mark Porter : Don’t think you can be too young to need a hip replacement) Dr Mark Porter explains the high standards and advances in Hip Replacement Surgery. He says “One simple way of getting the right operations done by the right surgeon is to ask your doctor where local GPs go when their joints start playing up”. This is of course a meaningless question in Wales unless you append, “firstly under the Welsh Health Service, and then, secondly privately?”.

By having one health board in Wales, there would be a choice in the whole of the principality, just as in England. The mutual sharing of risk and repair is better in a larger population. 3 million is a big improvement on 120,000. But it’s not as good as 65 million!

Dr Porter’s Article:

It has been a record year for hips according to the latest report from the National Joint Registry. The number of people having replacements in the UK is at an all time high and more of them are of working age — arthritis can afflict the young as well as the old — but what caught my eye was the shift in the type of artificial hips surgeons are now using.

A decade ago, when the registry first started monitoring outcomes in joint replacement, resurfacing was the new kid on the block and the preferred choice for many younger, active patients. However, concerns about longevity and the effects of tiny particles of chromium and cobalt, produced by wear between the metal ball and socket (so called metal-on-metal or MoM), has seen many surgeons stop using them. Resurfacing-type hips — where the ball part of the joint is covered with a cap rather than replaced — now account for only 1 per cent of the 90,000 new hips last year, down from 10 per cent in 2003.

Concerns about MoM hips have seen surgeons turn to tried and tested prostheses such as the Exeter hip, which uses a metal ball on a spike set into the top of the thigh bone, articulating with a plastic cup cemented into the pelvis (metal-on-plastic). But the MoM experience hasn’t stifled ongoing development in the quest for longer life, with ceramic-on-plastic and ceramic-on-ceramic looking the most promising newer alternatives.

Whatever the type of prosthesis, nothing lasts for ever. Still, the results of hip replacement are among the best of all surgical procedures and, in terms of patient satisfaction, pipped only by cataract surgery. Close to 90 per cent of patients report they are happy with their new hip but, as with all operations, things can go wrong, so here are a few tips.

Surgery is a last resort and self-help measures and medication should always be tried first. Painkillers, anti-inflammatories, physiotherapy, keeping active and losing weight (most patients undergoing hip replacement are overweight) can all help mitigate pain and stiffness and preserve a damaged joint. In general, exercise is to be encouraged. At worst such measures will make no difference or simply delay the inevitable, but at best they can avoid the need for surgery.

If you do need an operation, pick a good specialist (see below) and follow their advice as to what sort of prosthesis will suit best. Bear in mind that, on the NHS at least, you are not guaranteed to have a particular surgeon perform your operation. And performance data can be misleading depending on the type of work done by a unit, particularly if they tackle more challenging cases such as revising failed hips or treating younger people who tend to punish their new hips more. One simple way of increasing the odds of getting the right operation done by the right surgeon is to ask your doctor where local GPs go when their joints start playing up.

Everyone wants to know how long their new hip will last but that depends on a number of factors including the skill of the surgeon, the type of prosthesis, the weight of the recipient and how careful they are with it. Hips can still be going strong after 20 years but some will fail within five. One marker of longevity is how many people need to undergo repeat surgery (revision). According to the registry figures, the best results are for ceramic-on-plastic cemented hips, which have a revision rate of only 2 per cent at ten years (the more established metal-on-plastic equivalents come in at 3 per cent).

Serious complications following hip replacement are rare but include fracture, dislocation, infection and blood clots. However, in a good unit taking the right preventative measures (such as blood “thinning” agents to prevent clots) the frequency of “untoward events” should be 1 per cent or lower.

You can look up data on individual surgeons and specific hospitals at njrsurgeonhospitalprofile.org.uk to get an idea of how your “choice” performs compared with others, and the range of operations. When you look into the link, all the DGHs in West Wales are doing hips and knees. This is what is wrong……. One should be enough for a population of 3 million, but the geography, without transport infrastructure, makes two centres more practical.

Rachel Flint in The Daily Post 7th September 2015 reports: Plaid Cymru and the Welsh Labour row over Plaid’s promise to ring-fence £590m for Welsh NHS and explains that Plaid would train more doctors. What she does not say is that most of the Wales trained doctors leave – how would plaid change this? By promising more money, and doctors Wales would simply be subsidising the other UK regions. European legislation prevents Plaid restricting these doctors to Wales after qualifying with a “ball and chain” – freedom of movement of people. So without an overall UK plan for more doctors Wales is impotent. It’s all about money, and always has been The Slough and South Bucks Observer reports 24th November 2015: ‘Risks remain’ despite George Osborne’s £3.8bn cash boost for NHS

Leanne Wood claims “Wales has wasted 16 years of devolution” in Plaid Cymru aims to run health and education, Leanne Wood says. NHSreality agrees. Wales has less meaningful choice, and lower standards than England. Obfuscation of the figures means the people will have to wait until WHO reports on the differences in outcomes and life expectancy.

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This entry was posted in A Personal View, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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