Saturday, May 30, 2009

New cost-cutting NHS guidelines on back pain 'will lead to more surgery'

Thousands of patients could undergo unnecessary spinal operations because of new NHS guidelines on treatments for lower back pain, warn experts. Dozens of hospital consultants say the ‘cost- cutting’ restrictions mean more patients will end up having major surgery. They claim less risky procedures using spinal injections have been wrongly dismissed as ineffective, even though they help hundreds of thousands of patients with chronic back pain each year.

Guidelines issued earlier this week by the National Institute for Health and Clinical Excellence (NICE) set out permitted treatments for patients whose back pain has lasted for at least six weeks but less than a year. They endorsed widespread use of ‘alternative’ therapy, letting patients opt for a three-month course of acupuncture, manual therapy such as physiotherapy, or exercise.

Described as a ‘sea-change’ for back pain sufferers, the guidelines also told doctors not to recommend therapies with ‘little evidence’ to support them, controversially including injections of small amounts of steroids into the back, MRI scans, X-rays and ultrasound. Now, many patients who fail to respond to initial treatment could miss out this intermediate stage and proceed straight to risky spinal fusion operations.

NICE estimates the NHS will make annual savings of £33million on back injections and £11million on MRI scans. However, it will spend £24million extra on acupuncture and £16million extra on manual therapy, making the cost-cutting aspect negligible.

Around 50 specialists belonging to the Interventional Pain Medicine Group of the British Pain Society are writing to NICE, claiming it has dismissed good evidence about spinal injections, which do not cure pack pain but give a period of relief from chronic pain. Dr Ron Cooper, past chairman of the group and a consultant pain specialist in Northern Ireland, said: ‘I have never known so many pain medicine specialists to be so furious. More patients will end up having more expensive surgery, which is unnecessary, risky and has worse results.

‘NICE made it difficult for us to submit evidence to a committee on which there was not one experienced pain physician. [Very suggestive of a non-medical agenda] ‘The guidelines will make us the laughing stock of Europe, Australia and the U.S. where pain specialists will continue to have full access to a wide range of treatments.’ Dr Raj Munglani, a consultant in pain medicine at West Suffolk Hospital, Bury St Edmunds, said: ‘There could be as many as 400,000 patients (a year) who will be eligible for spinal fusion – when it should be a last resort. ‘There is a lot of concern that this is actually a way of banishing waiting lists for some procedures, because they will no longer be available.’ Dr Serge Nikolic, a chronic pain specialist at Bart’s hospital in London, said any savings made from the guidelines would be a false economy if they led to more spinal surgery.

A NICE spokesman said: ‘The guideline sets out... those approaches which either don’t work as well as alternatives, or for which there is little evidence of benefit. ‘The guideline recommends that new research is needed to decide if injections into the back are, or are not, effective.’


Australia: There is some accountability in government health systems after all

Nurse fired over baby left at Airport, though it seems that the aircraft pilot was also partly to blame. Any repercussions for him? None that we know of

A NURSE has been sacked and another has resigned over leaving a five-day-old baby with a stranger at regional airport in South Australia. In January, The Advertiser revealed the two nurses were suspended after they left the premature baby with a young woman at the Port Augusta Airport instead of delivering him to the hospital. The baby's father, Shahzad Hassan, said at the time that it had happened on Christmas Eve because the nurse was "in a hurry" to get back to Adelaide.

The baby, Rayaan, was left for about 10 minutes before hospital staff arrived. He was born six weeks early, which put him at risk of a range of complications and he had been sent home to Port Augusta by plane with the nurse while his parents drove.

The Government Investigation Unit confirmed last night that the nurse had resigned, while her superior – who gave her permission to leave the baby and return to Adelaide – was dismissed.

Child, Youth and Women's Health Service chief executive Gail Mondy said the staff had failed to follow proper procedures for the transfer of a baby, putting it at risk, and that they had apologised to the parents.

"We've taken steps to learn from this serious incident," she said. "We have apologised to the baby's parents and we very much regret that on this occasion the two staff involved failed to follow the hospital's and the Department of Health's patient-transfer procedures, which are designed to protect patients' safety and wellbeing."

When the plane landed in Port Augusta at about 7.40am, there was no one to meet the nurse accompanying the baby and the pilot told the nurse he needed to return to Adelaide immediately. The nurse became upset, at which point a young woman – believed to be a teacher – offered to mind the baby.

Mr Hassan said he welcomed the resolution of the case. "I can't really say anything else," he said. "I can only say that they did what they thought was right." Asked whether he was upset at the five months it took to finalise the case, he said: "I think they had to make sure of what they were doing."


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