How patients are being left in agony as the NHS cuts back on tonsil ops
It used to be routine surgery. Now it’s being rationed — but ends up costing MORE to treat
MANDY GEORGE thought little of the sore throat she felt coming on. With young children and a husband working nights as a computer engineer, she had little choice but to get through it.
‘It just felt a bit “scratchy” and I didn’t feel that under the weather at first,’ says Mandy, 43, a care worker from Jarrow, newcastle upon Tyne.
‘But over the next 24 hours or so it got much, much worse. My tonsils became really swollen and I felt tired to my bones. I couldn’t swallow properly and my neck was visibly swollen.
‘Then, suddenly, I grabbed my throat, turned to my husband Sam and gasped: “I can’t breathe”.’ Mandy’s tonsils had become so enlarged they were blocking the flow of air through her throat.
Sam, 43, called 111 and was told to take Mandy to a&e. There, she was put on an intravenous drip of powerful antibiotics and, over the next few hours, the drugs took effect. The swelling began to subside and Mandy’s breathing returned to normal.
But then the results of a blood test, taken to check for signs of bacterial infection, revealed something alarming.
Mandy’s levels of platelets — fragments of cells that help blood to clot — had plummeted. This meant she was at risk of bleeding to death from the slightest scratch.
The mother of three had developed immune thrombocytopenia, where the immune system attacks and destroys platelets, often as a result of a viral or bacterial infection such as tonsillitis.
Mandy, then living in Livingston, West Lothian, was transferred in the middle of the night to a specialist centre at the Western General Hospital in edinburgh, where she was given intravenous immunoglobulin, a blood product packed with antibodies that stop the immune system from attacking platelets.
after five days, she had made a full recovery but will need annual blood tests for the rest of her life to check her platelet levels.
although Mandy’s story might sound unusual, recent studies highlight a steep rise in hospital admissions for severe tonsillitis.
one published in the european archives of otorhinolaryngology last year found that between 2015 and 2019 there was a 25 per cent increase in admissions across four NHS trusts for peritonsillar abscess, a potentially fatal complication of tonsillitis where an abscess forms between the tonsils and the throat wall.
AS WELL as high doses of intravenous antibiotics, this requires emergency treatment to drain pus from the area, often under local or general anaesthetic.
A second study, by doctors at the rotherham Foundation NHS Trust and published last March in the journal annals of the royal College of Surgeons, found that since the late 1990s there has been a near-fivefold increase in cases of ‘deep neck space’ infections — a severe complication of tonsillitis, where infection takes hold around the tissues lining the throat and neck.
These two studies back up previous reports showing that the numbers of Britons ending up in hospital from tonsillitis has been on the increase for years.
The most likely explanation for this surge? Cutbacks in NHS tonsil removal surgery.
In the 1950s and 60s, around 250,000 patients a year underwent tonsil surgery in Britan.
However, large-scale studies began to question the value of routine surgery and suggested that, in children at least, many cases of recurrent tonsillitis gradually settle down.
And although once thought to be of little value, scientists discovered that tonsils are made of lymphoid tissue, which makes proteins to fight infections.
However, these same proteins are also released by other tissues around the body, so removing the tonsils doesn’t have a major impact.
Under NHS guidance, tonsillectomies should be carried out only under the ‘357 rule’. This stipulates that a child or adult must have had at least three bouts of severe tonsillitis a year for three consecutive years, five attacks a year for two years or seven attacks inside 12 months, in order to qualify for surgery.
as a result, tonsillectomies have dropped to just 40,00050,000 a year in england, a fraction of the number at the peak. So has the pendulum swung too far?
The rotherham study showed that, before the cuts in surgery, the NHS was spending around £71 million a year on tonsil removals and just £8 million treating severe tonsillitis. now the trend has gone the other way, with £73 million a year going on managing complicated cases of tonsillitis and just £56 million a year on surgery.
It means any savings made from doing fewer operations are more than overshadowed by the bill for treating sick patients.
‘These figures show that policies to control the number of tonsillectomies on the NHS over the past 15 years or so have gone too far,’ says Professor Tony narula, a retired ear, nose and throat (ENT) surgeon and past president of ENT UK.
‘The aim of not operating unless it is essential is a noble one. But if you factor in all the recurrent infections, the overall cost to the NHS may even be understated in these studies.’
Many tonsillitis cases, the rotherham team warned, end up needing ‘lengthy intensive care stays and a protracted course of rehabilitation’.
Professor nirmal Kumar, a consultant ENT specialist at Wrightington, Wigan and Leigh NHS Trust and president of ENT UK, adds: ‘We know that if you do too few tonsillectomies, then admissions to hospital for acute infections go up, and every day we see patients admitted with these kinds of infections.
‘Tonsillectomies are still an important operation; but we can’t go back to operating on hundreds of thousands of people every year, often unnecessarily.’
Mandy had suffered at least two bouts of tonsillitis a year from an early age, with lengthy periods off school.
The attacks continued into adulthood. ‘They last five or six days at a time and can be really debilitating,’ she recalls.
‘every time I’ve asked my GP about having my tonsils removed, I’ve been told there’s not enough evidence to support it, or that I wasn’t ill enough.
‘The irony is that my parents often treated me at home because they didn’t want to keep bothering the GP, but if they had then done there’s a good chance I would have been referred for surgery.’
The department of Health did not reply to a request from Good Health for a comment.