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OCT 01/2014

Ensuring older people have access to surgeries: how can the NHS help?

One of the most important ways in which the NHS is trying to improve its standard of service at the moment is in the provision of more tailored care for vulnerable older people.

In the last few months, the government has been vocal about its intentions to ensure different divisions of the health service work together closely to help the elderly receive joined-up care that tackles their problems proactively and makes them feel looked after as individuals.

However, a recent report has suggested one area in which further progress is still needed is in making sure older people have access to surgery - a problem that NHS surgical staff and managers can play a big role in solving.

Is age a barrier to surgery?
The study - from the Royal College of Surgeons (RCS) and Age UK - analysed surgery rates across England's 211 clinical commissioning groups (CCGs) for six common procedures that are known to be effective in older people, such as breast or colorectal excisions, gall stones, hernia repair, colorectal incision and knee replacements.

It was found that widespread variations exist in the rates of surgery for people aged over 65 and over 75 exist depending on where they lived, with almost one-fifth of CCGs recording a decline of more than 25 per cent in at least three procedures between patients aged over 65 and over 75.

The discrepancy was most pronounced among over-65s living with breast cancer, with a 37-fold difference in the rate of breast excision.

According to the study, there are a number of reasons why this may be the case, most of which revolve around the perceived physical health of a patient and their subsequent suitability - or otherwise - for surgical interventions. The organisations producing the report said many care providers are not correctly gauging how resilient older people can be, nor are they accounting for the emergence of robotics, minimally invasive techniques and new anaesthetics that render surgery safer than ever.

How can medical staff help address this?
As such, commissioners have been urged explore their data and understand why they may have higher or lower rates of surgical intervention, while health and wellbeing boards have been advised to conduct robust assessments to ensure the needs of older patients are being met.

From a frontline perspective, the important lesson to be learned is the need to abandon outdated assumptions about a person's fitness based on age alone, making it easier for surgeons and GPs to refer people for operations based on their clinical need, rather than their seniority.

As well as improving the health of the patients in question, this could bring benefits from an efficiency perspective, as it would reduce demand for ongoing social care support or expensive drugs to manage symptoms.

Professor Norman Williams, president of the RCS, said: "This report raises important questions about how we treat older people on the NHS and whether they have access to the type of surgery they need. Every patient must be treated as an individual and, when a decision is made about their treatment, they must be judged according to their physiological age - how healthy they are - rather than their chronological age."

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