-----Original Message-----
From: Adrian Midgley <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: 23 April 1998 11:06
Subject: Re: Health Priorities


>But neither retraining general surgeons to do coronary bypass work, nor
>leaving general surgeons standing idle until the limited number of
>heart surgeons have finished all their work is altogether sensible.


Yes, setting priorities must consider the most efficient use of resources

>And from the point of view of a patient with eg an inguinal hernia,
>say, which stops him working and supporting his family an makes them a
>charge on the State instead of a contributor to supporting expensive
>people like cardiac surgeons and their nurses.... unlikely to be
>impressed with a strict order of mdical urgency arrangement.

The Salisbury scoring system is designed to put a weighting on factors such
as effect on work, disablity, pain and likelihood of complications if there
is delay in treatment.  Some patients have a very low Salisbury score and
yet they must be operated on at 18 months. Given present resourcing they
would never reach a priority sufficient to be operated on.  However the
government says there is no rationing, only priority setting so we are
caught in a cleft stick - if we refer we use scarce resources inefficiently,
if we don't we are rationing and this doesn't exist in the NHS according to
Alan Milburn

>
>Even the varicose vein bit is not so simple.  If the veins progress to
>ulcers we may use as much as half a nursemorning per week on looking
>after them, which should be translatable into cardiac surgery if it
>could be avoided.

Come off it!  It isn't too difficult to decide which varicose veins may
present a risk.  Minor cosmetic varicose veins are a very low priority in my
book.





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