Just op abroad

FOR those people who have been languishing on hospital waiting lists in the hope the NHS will one day get round to giving them a new hip or knee joint, the prospect of being sent to a European hospital will probably bring mixed feelings.

Some people - especially those in great pain - offered a quick operation in France or Germany would no doubt welcome the chance. Others, particularly those who are very ill or vulnerable, may be terrified at the thought of ending up in a strange hospital where no one even speaks our language.

They need not be worried, says Sue Ross, chief executive of York's new primary care trust. Despite the announcement by health secretary Alan Milburn recently that British patients could be sent for treatment to European hospitals to cut waiting lists at home, nobody is ever going to be forced to go abroad for treatment if they don't want to.

If Sue says that's so, you can rest assured it is so - because it's her primary care trust that will be paying for beds in European hospitals for York patients.

So no fears of Britain's growing army of waiting-list patients being shipped abroad on a giant Government transport ship to allow the NHS to wash its hands and claim to have cleared the operations backlog at a stroke.

The very fact the Government is being forced to consider 'buying' spare capacity in European hospitals to bale out an overstretched NHS, however, simply reinforces our image as the sick man of Europe. Which other country, critics jeer, has managed to get itself into such a mess it needs to import teachers and nurses and export patients?

Nevertheless, the proposal is a serious one - and if it means quicker treatment for thousands of patients anxiously waiting for an operation that could transform their lives, it should be welcomed.

One who certainly welcomes the idea is Derek Smith.

Almost two years ago Derek, a 65-year-old retired chiropodist, was told during a routine visit to his optician that he was developing a cataract in his left eye.

He has been waiting for an operation to remove it ever since. Two years ago his vision wasn't too bad, but now he is almost blind in his left eye.

"It is very, very frustrating," says Derek, from Bishopthorpe. "At least I'm not in pain, or anything like that. But I am virtually blind in my left eye. I can perceive light, but I can't distinguish anything. I keep on bumping into people in supermarkets."

What makes it even more frustrating is that the operation to remove the cataract takes only about 20 minutes. The problem is the sheer number of people waiting for the operation in the York area - and the fact the city's eye unit is stretched to breaking point trying to keep up.

Derek doesn't blame medical staff at York District Hospital, who he accepts are struggling to cope. It's not even entirely the hospital's fault he has had to wait so long, he admits. If it hadn't been for the fact he was suffering from high blood pressure in July he would have had the operation then. Instead, it had to be delayed.

Even so, had the operation gone ahead it would still have been a wait of 21 months from the time he was first alerted by his optician in October 1999 - a wait he thinks is unacceptable.

A year or so ago, he was so disheartened at the thought of endless months waiting with increasingly poor vision that he seriously considered going to India for the operation. An article in a national newspaper had revealed that, even taking into account transport and accommodation costs, it would be far cheaper having the operation done there than going private here: something he couldn't afford.

In the end, he didn't go. Further investigation revealed hidden costs - and there was always the worry of what would happen if something went wrong after the operation.

Hopefully, it shouldn't be too long before his rescheduled operation takes place - but if a year or so ago he had been offered the chance of a quick operation in Germany, he would have jumped at it, he says.

"I think it's great. It wouldn't worry me at all." he said. "I would take my wife with me to look after me, and it would be like a bit of a holiday."

But what about the thought of recovering from the operation in a country where nobody spoke his own language? "We enjoy travelling. I get by in French and Spanish, so it wouldn't be a problem - though I don't speak much German. I was a soldier in Germany, but that was a lifetime ago."

Is there really any prospect of York patients being offered the chance of treatment in European hospitals, though? Yes, says Sue Ross, there is. It's early days yet, and the details of the Government's proposals still aren't clear - but in principle, she says, the York primary care trust wouldn't object to the idea.

It would have to be done properly, though - and there would be problems to overcome.

The patients who may benefit most from overseas operations might be those waiting for hip or knee replacements, says Sue, but they tend to be older people, who may be least likely to welcome a trip to a foreign hospital and who would most miss the support of family nearby.

Having family around to support you while you recover from an operation is extremely important, she says - and if you're sent abroad for your op that may not be possible.

"I would be particularly concerned about elderly people and disabled groups, who do depend more on having their family near," she says.

She said another big problem would be follow-up care. If a patient needed further care after the initial operation, it could be costly if it involved specialists at a foreign hospital - not to mention inconvenient for the patient.

It's a worry shared by Simon Pleydell, chief executive of York District Hospital.

"I don't have a problem with the concept," he says. "But our preference will always be to achieve the capacity to treat the people of York in York.

"There is no argument about the need to reduce waiting times, but if we arrange for the work to be done elsewhere, the issue will be follow-up. The management of orthopaedic patients needs to be thorough. The operation itself is just part of a patient's pathway."

Mr Pleydell makes it clear there would be a cost to sending patients overseas - and that he would prefer to see that money ploughed into improving services here. The hospital is already taking measures to cut waiting times, with a new eye unit to be built, for example, and steps are being taken to reduce bed blocking and use spare capacity in local private hospitals.

But these measures require money, involve improving local services and staff recruitment to cope with demand. All of which takes time.

So in the short term, some York patients may well find themselves being offered treatment in a continental hospital. They will always be able to say no. But adventurous patients should start brushing up their French and German... just in case.

Updated: 10:44 Thursday, September 06, 2001