Eddie Chaloner of Radiance Health provides the arguments for going private to have your varicose veins treated.

A lot of patients suffering from varicose veins wonder whether they should choose to seek private medical care or stay with the NHS provision. After all, the NHS provides a very good service for most people and, although it might not always provide the flexibility that can be achieved in the private sector, it has the very significant advantage of being free at the point of use. For various medical conditions, the NHS is still the preferred option for many patients.

For varicose veins, however, the situation is quite different. There are now several very good reasons why patients should seek vein surgery in the private sector and avoid the NHS.

Reason 1: Can I get varicose vein treatment on the NHS?

For a start, the NHS is now imposing restrictions on the provision of surgery for varicose veins in most parts of the country. In the past, patients with sore, aching or swollen legs caused by bad veins were allowed to have treatment on the Health Service including definitive operations. Unfortunately, that is no longer the case.

Over the last few years, most NHS districts have introduced lists of procedures, which are referred to as being ‘of limited clinical value’. What this means is that the operations don’t really work, or, the advantages to the patient are minimal. The list started out with procedures like cosmetic surgery, but, over the years, it has widened to include groin hernias, varicose veins, cataract surgery and now even hip and knee replacements in some patients.

It is simply not credible that all these routine operations, previously done by the thousand each year in the NHS have suddenly stopped working. The Royal College of Surgeons has issued several strongly worded statements to the effect that this restriction is simply a form of health care rationing implemented to save money.

Nevertheless the restrictions are being very firmly implemented indeed, so it is now very difficult to get your veins operated on in the Health Service unless they are so bad that they are about to give you a venous ulcer at the ankle. The restrictions have effectively eliminated the NHS option for 50% of patients suffering with varicose veins.

Reason 2: What type of surgery will I get with the NHS?

The next reason for seeking private treatment relates to the type of surgery that you will be offered on the NHS. Vein surgery has come a long way in the last 10 years – in fact, there has been something of a revolution in care with best practice moving away from the old-fashioned ‘high tie and strip’ operation towards minimally invasive procedures, most of which can be done under local anaesthetic, without the need to keep the patient in hospital and with very rapid recovery times.

Most patients prefer the minimally invasive option for these reasons and, in addition, the new techniques have a lower rate of recurrence than the old style operations, which had a 30 % recurrence rate at 5 years after surgery.

Despite the obvious advantages of the new operations such as EVLT laser treatment or VnUS closure, two-thirds of patients in the NHS still have their surgery done by the old-fashioned ‘high tie and strip’ method. At first sight, it might seem illogical for the Health Service to ignore advances in surgery, which are clearly to the benefit of patients. However, the chart below explains some of the reasons for this.

As can be seen, the total number of vein operations done in the NHS has been falling substantially for the last 3 years and is set to fall still further. Faced with this backdrop, NHS Trusts are unwilling to invest in the equipment and training needed for their staff to learn the new minimally invasive techniques – simply put, for the NHS, vein surgery is no longer a priority. In addition, a substantial percentage of vein surgery done in the NHS is not done by specialist vascular surgeons – patients with veins are often seen by ‘general surgeons’ who do a variety of operations other than purely on blood vessels. As non-specialists, they have less time and perhaps less incentive to take the time to learn the new and more effective vein procedures.

Reason 3: Who will actually perform your treatment?

When you visit a surgeon in the private sector, you will know, or should know, who will actually be doing your operation. In the NHS however, in most cases the person you see in the clinic will not be the person performing the operation. In most hospitals, lists are ‘pooled’ as this is thought to improve efficiency and help Trusts hit centrally imposed waiting time targets. The majority of the varicose veins treated in the NHS are not operated on by consultant surgeons and not even operated on by specialist vascular surgeons. Most cases are done either by surgeons in training or by other surgical staff. A relatively small percentage of cases are personally performed by specialist consultant vein surgeons for whom vein surgery constitutes the majority of their practice.

So in conclusion, although it is possible to get the latest vein treatments done in the NHS by a consultant vascular surgeon with a particular interest in vein operations, this is the exception rather than the rule. In the majority of NHS hospitals, vein operations are carried out by non-specialist, non-consultant grade staff using outdated and less effective open surgical techniques.

If you want the choice of the latest minimally invasive, local anaesthetic techniques carried out by the specialist of your choice, then the easiest way to get this is in the private medical sector.

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