PATIENTS with ailments that could be cured by drugs are instead undergoing unnecessary and painful surgery simply because of where they live, according to England’s Chief Medical Officer.

Professor Sir Liam Donaldson said that by scrapping operations such as hysterectomies and tonsil removal the NHS could save billions of pounds a year.

His annual report, which was released yesterday, calls for urgent action to reduce the wide variations in care experienced across the country and urged the National Institute for Health and Clinical Excellence to issue guidelines on which treatments doctors should stop prescribing.

Sir Liam said that tonsillectomies and hysterectomies were still regularly performed despite guidelines recommending treatment through drugs. He said that children from low-income areas were more likely to have their tonsils removed, but if the tonsillectomy rate in low-income areas matched that of higher-income ones, about 8,000 operations could be avoided every year, saving about £6 million.

Doctors performed about 38,000 hysterectomies in 2004-05. However, there were fewer operations in north central London than in Northumberland and Tyne and Wear.

“In my view, this level of variation in clinical practice is not acceptable,” Sir Liam said.

“If the average rate of hysterectomy in England could be reduced to that achieved in the 20 per cent of the country with the lowest current rates, then 5,900 operations, costing £15 million, could be avoided per annum.”

Sir Liam’s report also highlighted the wide variations in the treatment of coronary heart disease. In some parts of the country, heart attack patients who needed revascuralisation — a procedure that improves blood flow to the heart — were twice as likely to be offered less intrusive but just as effective operations as those in other areas.

Another example of waste was the 574 different hip joints the NHS used. He said that these could be reduced significantly.

Sir Liam proposed a system of incentives and penalties to encourage doctors to prescribe appropriate treatments. He said that computers in hospitals and GP surgeries could be programmed to block a doctor from prescribing a treatment that had little or no evidence of its worth.

The NHS could also learn a great deal from the aviation industry and adopt standard operating procedures. This would not only encourage equitable care but also help to ensure better patient safety, Sir Liam said.

“Inappropriate variation may be a function of poor knowledge, the flawed application of the correct knowledge, a lack of resources or the inappropriate allocation of extant resources,” he said.

Asked whether spending on inappropriate care was costing the NHS billions of pounds, Sir Liam replied: “Yes, it would be very large sums of money.”

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