Clear North-South divide in number of hysterectomies (U.K.)

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http://www.timesonline.co.uk/article/0,,8122-881326,00.html

 

November 05, 2003

 

Clear North-South divide in number of hysterectomies

By Nigel Hawkes, Health Editor

HYSTERECTOMIES are five times as common in some areas as they are in others,

although women’s health problems are much the same everywhere, tables published

in The Times today show.

The statistics, the latest to show a postcode lottery in healthcare, demonstrate

confusion about the role of hysterectomies in treating conditions such as heavy

periods.

While guidance from the Royal College of Obstetricians and Gynaecologists

recommends fewer hysterectomies for such conditions, many surgeons and patients

continue to believe that the operation is often justified and women’s lives

improved by it.

Such is the difference of opinion that in March the Department of Health and the

Welsh Assembly asked the National Institute for Clinical Excellence (NICE) to

examine the use of hysterectomy and alternative surgical treatments for

menorrhagia, the technical term for heavy periods. The guidance will not,

however, be ready until September 2005.

Hysterectomy rates in England have fallen since a survey in the 1990s suggested

that a third were not medically justified. The same survey showed that almost

half were then being done for menorrhagia.

Sandra Simkins, of the Campaign against Hysterectomy, said that women were still

not being given the choice. “Education is a key factor: it’s so much easier for

a doctor to coerce a woman if she isn’t educated.” She also blames

gynaecologists: “Gynaecologists sometimes perform hysterectomies simply because

it’s the way that they’ve been taught to deal with certain problems. They don’t

stop to consider the less invasive techniques they could use.”

The tables in today’s Hospital Consultants Guide show that some primary care

trusts, which are responsible for commissioning hospital care on behalf of

patients, pay for fewer than half as many hysterectomies as the average, while

others pay for almost twice as many as the average.

The range between lowest and highest (Cambridge City Primary Care Trust and

Cannock Chase Primary Care Trust) is a factor of five. These differences broadly

reflect the practice in local hospitals but cannot be attributed to a specific

hospital since trusts may commission care from several.

No very clear pattern emerges from the tables, except that there is a distinct

North-South divide, with most high-hysterectomy primary care trusts in the

Midlands and North.

Jenny Higham, a gynaecologist at St Mary’s Hospital in London, said:

“Hysterectomy has become a dirty word but it cannot be denied that the operation

has some of the highest satisfaction levels. What we need to look at is whether,

in areas where the rates are low and high, patients felt well informed and were

satisfied with (their) treatment.” The Department of Health said: “We are aware

of the variation in hysterectomy rates and that is why ministers have referred

the issue of hysterectomy to NICE for clinical guidelines. The department works

closely with the Royal College of Obstetricians and Gynaecologists to put

doctors and women in a position where they can make an informed choice.”

 

 

 

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