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NHS TELLS BOURNEMOUTH WAR VETERAN HE CAN'T HAVE £30K OPERATION (From Bournemouth Echo)
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NHS TELLS BOURNEMOUTH WAR VETERAN HE CAN'T HAVE £30K OPERATION
7:00am Thursday 4th June 2009
HE worked hard for most of his life and spent six years fighting for his country in World War Two. Only now, aged 96, has Charles Coutts asked for anything in return.
The Burma campaign veteran needs a life-saving heart operation, and although doctors in London say he is a perfect candidate for a new procedure to replace a faulty valve, NHS Bournemouth and Poole has refused to foot the £30,000 bill.
“I’m not a moaner or whiner or a grabber. I’ve always been active, I’ve never had a major illness or operation, and I’m in generally good health apart from this valve,” said Mr Coutts, of Queens Park, Bournemouth.
“For the last six months I’ve been existing on tenterhooks thinking I’m going to have the operation, then being told I’m not because they’re not paying the money.
“I have deteriorated. I have no strength. I have to struggle to get off the chair and I have falls. It’s depressing not to be able to do anything unless somebody helps you. I don’t want to continue my life like this.”
Widower Mr Coutts was diagnosed as having a narrowing of his aortic valve after suffering an angina attack in Spain last year. When he returned home, he was referred to St Thomas’ Hospital in London.
After several days of scans and tests, he was assessed as ideal for transcatheter aortic valve implantation. The procedure involves inserting a replacement valve through a tube instead of undergoing open heart surgery.
Mr Coutts’ son Douglas pointed out that the procedure had been successfully carried out on people of 99 and 100. “It’s not a question of age. If my father lived in London or Kent, there’s a blanket go-ahead.”
And friend Jane Arnold said: “It’s a death sentence if he doesn’t have this done.”
Mr Coutts was born in the slums of the East End of London, the tenth surviving child in his family. After joining the Hampshire Regiment, he was commissioned into the Somerset Light Infantry, rising to the rank of Major. He spent most of his working life in the drapery trade, ending up as a director of the House of Fraser. He still lives independently.
A spokesperson for NHS Bournemouth and Poole said: “This is a highly specialised, complex and evolving procedure that is not currently routinely available in Bournemouth and Poole and is only considered for those too ill or frail to undergo open heart surgery.
“National guidance makes clear that although there is some evidence of short-term efficacy, there is little evidence about long-term outcomes.
“There is the potential for serious complications, which include the need for emergency cardiac surgery.
“Individuals may request specific funding through demonstrating to the primary care trust that they have good clinical reasons for being treated as an exceptional case. The PCT has not supported any such applications.”
Factfile
NHS trusts have a legal obligation to provide treatments that have been approved by the National Institute for Health and Clinical Excellence.
But the one recommended for Mr Coutts is classed as an “interventional procedure”.
NICE makes no ruling on whether or not these should be funded.
This is an apparent loophole in attempts to end the so-called “postcode lottery” of access to new drugs or treatment varying according to where you live. A Department of Health spokesperson explained: “In the absence of NICE guidance, primary care trusts have to make decisions locally on the basis of the available evidence. The fact that there is no NICE guidance is not an excuse to refuse funding for a drug or treatment.
“For the first time, the NHS Constitution gives patients an explicit right to expect, where NICE guidance is not available, local decisions on the funding of treatments for individual patients to be made rationally, following a proper consideration of the evidence.
“If the local PCT decides not to fund, then it should explain that decision. To underpin this right, we have issued directions that require NHS organisations to put in place clear and transparent arrangements for local decision-making on exceptional funding requests. The directions came into force on April 1.”
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Your Say YourEcho
BIGTONE, POOLE says...
7:53am Thu 4 Jun 09
CC C-siders wrote:Well we all have the chance to be selective today in the polling booths.
So much for all our hard earned tax-payers cash being pumped into the Health Service!
Thanks Gordon Brown - a great display of your caring credentials ; how very SELECTIVE of you.
Good luck Mr Coutts
People power always prevails.
GAHmusic, Bournemouth says...
8:19am Thu 4 Jun 09
mike1213, verwood says...
8:22am Thu 4 Jun 09
The-Bleeding-Obvious, bournemouth says...
8:32am Thu 4 Jun 09
Im amazed they can give so many reasons for not doing it without mentioning this mans age; and how can it cost £30k, more than most people earn in a year!
Adrian XX, Poole says...
8:34am Thu 4 Jun 09
It is a risky procedure. Have a look at this: http://tinyurl.com/p
d8ur5
"With experience... 30-day mortality fell from 16% to 8%..."
However, the patient is 96 years old and the risk from conventional aortic valve replacement: cutting open the sternum, putting him on a heart lung machine and stopping his heart to operate is very high.
I would be wanting to ask Bournemouth Hospital a few questions: How many of these (transcatheter) procedures have you carried out? How many were successful? How many were successful? What degree of follow up did you have with the patients?
Perhaps it is possible for him to go to Southampton or London instead?
butlincat, bournemouth says...
9:25am Thu 4 Jun 09
2Much...again!, Ringwood says...
9:44am Thu 4 Jun 09
He's 96...how long-term does is have to be...do the right thing NHS..let this man have his last piece of life in quality!
West Howe Sean, Bournemouth says...
10:48am Thu 4 Jun 09
essexman2, gersau@gersau.plus.com says...
10:54am Thu 4 Jun 09
bex1984, poole says...
11:12am Thu 4 Jun 09
matthewsad, bournemouth says...
11:13am Thu 4 Jun 09
Daff Sullivan, Bournemouth says...
11:13am Thu 4 Jun 09
After spending over 7 weeks in both Bournemouth and Southampton hospitals after suffering breathing difficulties brought on by the block aortic valve my mother was accepted by the team of 6 Heart Specialist in Southampton General Hospital for the Transcatheter Aortic Valve Implantation (TAVI) operation, but then the Dorset Primary Health Care Trust (PCT) in their wisdom refused funding !
After speaking to a member of the the PCT I was told that more research was required by Dorset before they would agree to funding for this relatively new operation, although I have been told by a professional in Southampton General Hospital that if my mother lived in Hampshire, she would have been funded this operation. Well, this operation, which was developed for people like my mother and Charles Coutts !! may be new in Dorset but it is widely used in America, and Europe where all the research has been carried out and people are surviving. I was told that there are other options available for these people but tell me the options they can have because I don’t see them!
I was told that there would have to be exceptional circumstances before they would consider her…………..wel
l not being able to breath is a major reason for being accepted for this operations, the other option is not breathing………
…………….doe
s that seem like an option to you? I was also told that two other people were turned down for this operation a while ago, that makes 4. Why should these people have to fight to stay alive !!! I am so angry that after living over 54 years in Dorset they are treating her like this.
Think about it, the cost to the NHS of continuing care must be astronomical – and will continue to do so.
Daff Sullivan, Bournemouth says...
11:14am Thu 4 Jun 09
After spending over 7 weeks in both Bournemouth and Southampton hospitals after suffering breathing difficulties brought on by the block aortic valve my mother was accepted by the team of 6 Heart Specialist in Southampton General Hospital for the Transcatheter Aortic Valve Implantation (TAVI) operation, but then the Dorset Primary Health Care Trust (PCT) in their wisdom refused funding !
After speaking to a member of the the PCT I was told that more research was required by Dorset before they would agree to funding for this relatively new operation, although I have been told by a professional in Southampton General Hospital that if my mother lived in Hampshire, she would have been funded this operation. Well, this operation, which was developed for people like my mother and Charles Coutts !! may be new in Dorset but it is widely used in America, and Europe where all the research has been carried out and people are surviving. I was told that there are other options available for these people but tell me the options they can have because I don’t see them!
I was told that there would have to be exceptional circumstances before they would consider her…………..wel
l not being able to breath is a major reason for being accepted for this operations, the other option is not breathing………
…………….doe
s that seem like an option to you? I was also told that two other people were turned down for this operation a while ago, that makes 4. Why should these people have to fight to stay alive !!! I am so angry that after living over 54 years in Dorset they are treating her like this.
Think about it, the cost to the NHS of continuing care must be astronomical – and will continue to do so.
Douglas Charles, Felsham says...
11:30am Thu 4 Jun 09
AdrianXX has said that it is possible that the procedure could be carried out elsewhere. Indeed it could only be carried out at a few specialist hospitals. My father has had tests at St Thomas' Hospital in London taking several days and they are convinced that he is perfect for the procedure. It has always been proposed, by specialists at Bournemouth General (who have been marvellous), that the procedure should be carried at in London.
In reply to essexman2, my father himself has said that it seems at lot of money for someone of his age! However it has been pointed out to him that, from an economic point of view, the procedure would make sense. As it is my father has falls requiring expensive response from the emergency services, has had to return to hospital on several occasions and, without this intervention, will gradually need more and more medical care. This could well save scarce resources in the long run.
Emulated, Bournemouth says...
11:37am Thu 4 Jun 09
Hooky, Bournemouth says...
11:44am Thu 4 Jun 09
rayc, Wimborne says...
12:26pm Thu 4 Jun 09
tomtit, springbourne says...
12:32pm Thu 4 Jun 09
verwoodbadger, Verwood says...
12:41pm Thu 4 Jun 09
NHS Bournemouth & Poole (the PCT) have to make decisions as to how best to spend their limited funding and I expect that you will find that although they have not agreed to fund this operation some procedures which are funded locally are not available elsewhere in the country. There just isn't enough cash in the coffers, although if our crooked leaders in London didn't steal so much from the public purse perhaps there would be!
tomtit, springbourne says...
1:56pm Thu 4 Jun 09
Zzzz, Poole says...
4:06pm Thu 4 Jun 09
And why should healthcare be refused or scaled down for those over a certain age? I'm sure the NHS could save a load of money by not treating anyone over the age of 50 (or the obese or smokers), but that doesn't make it right.
Dorsetbaby, Poole says...
4:10pm Thu 4 Jun 09
Good luck Mr Coutts
Trifecta, Southbourne says...
4:16pm Thu 4 Jun 09
tomtit, springbourne says...
4:32pm Thu 4 Jun 09
dan ecan, bournemouth says...
4:44pm Thu 4 Jun 09
thesyrup1, Bournemouth says...
6:43pm Thu 4 Jun 09
e to England 2009
djd, bournemouth says...
7:11pm Thu 4 Jun 09
victoria71, Stratford upon Avon says...
8:34pm Thu 4 Jun 09
Emulated, Bournemouth says...
10:21pm Thu 4 Jun 09
verwoodbadger wrote:They have enough funds to treat those with sexual diseases. I know a hospital worker who told me they are clogging up the corridors waiting for treatment and the behaviour and language of some is appaling. Money for them, no problem.
Regardless of what the PCT are saying about 'insufficient evidence', 'new procedures' etc this is all about the availability of funding; and the sad fact is that these procedures cost a lot of money no matter where they take place. NHS Bournemouth & Poole (the PCT) have to make decisions as to how best to spend their limited funding and I expect that you will find that although they have not agreed to fund this operation some procedures which are funded locally are not available elsewhere in the country. There just isn't enough cash in the coffers, although if our crooked leaders in London didn't steal so much from the public purse perhaps there would be!
rw, East Dorset says...
1:57am Fri 5 Jun 09
Scrap everything that is unnecessary- nuclear weapons, war, arms manufacture, politicians (and their expenses) etc, etc, etc, you get my drift.
Don't cut taxes but spend the money on important things like healthcare, education, the environment etc, etc, etc.
It doesn't take a genius.
fedupwithjobsworths, Moordown says...
8:38am Fri 5 Jun 09
I assume “NICE” stands for Not Interested in Curing the Elderly?
jonathan.howell, Brocton says...
12:34pm Tue 9 Jun 09
Replacing diseased aortic valves is usually carried out on the NHS by major heart surgery and is funded to the order of £20,000 for a patient undergoing the procedure and the aftercare. It is a very successful operation with several thousand carried out across the NHS each year. However, some patients are judged not to be fit enough for such a major operation. There is now a new way of replacing the valves (called TAVI) through a catheter (basically a fine tube) passed up through an artery. Whilst this clearly saves a big operation for the patient we really don’t know how well it works overall and which patients are likely to benefit from it. So far the cases that have been done report mortality rates of the order of 10-20% at 6 months after the procedure, which is a worrying figure for someone like me advising on which things should be funded or not.
What we have been trying to do is work with the leading national doctors in this area to arrange a proper research trial where we can learn a lot more about TAVI and how we might use it in the NHS. This takes time and I would not be doing my job if I allowed my management colleagues to rush in and fund TAVI without knowing that it really helps patients. If we don’t do the proper research we might find that it takes 20 years before we can work out whether it harms more patients than it helps and that we have wasted NHS money that would otherwise have been used to help patients elsewhere.
Overall a promising new development but we need to proceed carefully to get the most for patients and the NHS
Jonathan Howell
Consultant in Public Health
Douglas Charles, Felsham says...
4:03pm Tue 9 Jun 09
He is, of course, correct in saying that this is a complex issue.
However, the last NICE guidance to be published on this procedure was in June 2008 using data collated in December 2007; some of which dates from 2004.
There were widely differing results from this procedure, particularly early on.
One reason for this is that many of the patients had a significant degree of CO-MORBIDITY. The procedure is used when the risk of mortality from normal surgery is, often, greater than 28%, and when the prognosis for the patient is certain death without intervention.
Even so NICE states that 'Current evidence on the safety and efficacy of balloon valvuloplasty for aortic valve stenosis....appears ADEQUATE TO SUPPORT THE USE OF THIS PROCEDURE...'
In my fathers case he has been assessed by the FOREMOST authorities performing the procedure as being an ideal candidate. He has NO SIGNIFICANT CO-MORBIDITY.
Without this procedure, my father is deteriorating rapidly and becoming very depressed.
Mr Powell, my father would be very happy if this procedure enabled him to live an independent life for a few more years. This is something that the Bournemouth PCT is supposedly committed to (see Mrs Fleming, the Chief Executive's own video).
Without this procedure he will die after experiencing an increasing lack of oxygen in his blood and all the disability that this entails.
Jonathan Powell is, obviously, correct in stating that it would be ideal for future assessment if there were detailed trials. However, this is an evolving process and such trials would take years to evaluate, and when evaluated, be out of date.
How many people must die before Bournemouth & Poole NHS join the many PCTS funding these operations. These include Hampshire and Dorset!
The decision not to fund my father's procedure was taken by people who have never examined him, and before his assessment by St. Thomas' Hospital at the end of March; and who have not even spoken to the experts in this field.
My father is aware of the risks, but feels that his current quality of life is not viable and that his undergoing the procedure may help others in the future, if not him now.
HEART OPERATION PLEA: War veteran Charles Coutts, 96, who needs a £30,000 procedure
Burma veteran: Charles Coutts in his army days
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CC C-siders, Winchester says...
7:18am Thu 4 Jun 09
Thanks Gordon Brown - a great display of your caring credentials ; how very SELECTIVE of you.
Good luck Mr Coutts