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Age still a barrier to surgery, RCS and Age UK warn

03 July 2014

Age discrimination in the NHS may still be preventing older people from having access to life-saving surgery, a report by the Royal College of Surgeons and Age UK warns.

An analysis of surgery rates across England’s 211 Clinical Commissioning Groups (CCGs), for six common procedures which are known to be effective in older people, shows there was widespread variation in the rates of surgery for people aged over 65 and 75, depending on where they live.

Operations for procedures to remove cancers of the breast and colon can be life-saving; while surgery to replace a hip, or repair a hernia, has the potential to transform a person’s life by alleviating pain, allowing them to regain their mobility and independence and by relieving stress.

However, the study finds that a number of CCGs have very few people in the over 75 age group who have received surgery for the procedures analysed – including for breast excision, gall stones, hernia repair, colorectal incision and knee replacements.  It warns that almost a fifth of CCGs recorded a decline of more than 25 per cent in at least three procedures between patients aged over 65 and over 75.

People living with breast cancer who were aged over 65 faced the biggest variation in access to surgery depending on where they live - with a 37-fold difference in the rate of breast excision (removal of breast tissue).

Data examined included rates of breast excision, colorectal excision, removal of the gall bladder, hernia repairs, hip replacements and knee replacements in 2011-2012.

The report, ‘Access All Ages 2: variations in access to surgical treatment among older people’, builds on a previous study, published by the Royal College of Surgeons and Age UK in October 2012, which first raised the issue of whether a person’s age restricted their access to surgery.

The President of the Royal College of Surgeons, Professor Norman Williams, said:

“This report raises important questions about how we treat older people on the NHS and whether they have access to the type of surgery they need.  Every patient must be treated as an individual and, when a decision is made about their treatment, they
must be judged according to their physiological age – how healthy they are – rather than their chronological age.

“Many older patients with common health problems – such as a very painful hip – need costly drugs to alleviate the pain and social care to help them live.  Clinical Commissioning Groups could actually save money by commissioning operations which would help a patient to regain their independence and mobility.

“This is why it is crucial that surgeons and GPs refer people for an operation on the basis of their clinical need and not their age.

“It is also important for the public and commissioners to realise how much safer surgery is than it used to be – we now have robotics, minimally invasive techniques and anaesthetics which mean patients can recover much quicker.”

The report makes clear that there may be legitimate reasons why a patient may not undergo surgery, including if a patient opts not to, for example.

It urges commissioners to explore their data and understand why they may have higher or lower rates of surgical intervention to make sure they are providing the best health service possible for the population they serve.

It also advises health and wellbeing boards to conduct a robust assessment of the needs of the over 65s and oldest population as part of the joint strategic needs assessment (JSNA).

Caroline Abrahams, Charity Director at Age UK, said:

“Treatment of older people must be based on their needs and a true picture of their health, not just their age. This report raises serious questions about how local areas support older people accessing surgery. Whether it’s referral practices, decision-making around treatment or how well older people are supported to remain resilient in the face of surgery, the extent of variation suggests many places could be doing better.

“Out-dated assumptions about fitness based on age alone have no place in decisions around surgery. For local areas to achieve the best possible outcomes they must assess older people's overall state of health, support them to manage any complications resulting from living with a long-term condition and take steps so that they are in the best possible health at the time they undergo surgery.  We must consign age discrimination to the past.”

Access All Ages 2: variations in access to surgical treatment among older people

Notes to editor:
For more information, please contact the RCS press office on:

1.    The Royal College of Surgeons of England is committed to enabling surgeons to achieve and maintain the highest standards of surgical practice and patient care. Registered charity number: 212808.
2.    MHP Health is an award-winning specialist health policy and communications consultancy.