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Mark S. Whiteley

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Support Stockings - A 'Sticking Plaster' for the NHS?

Posted: 19/12/2012 14:45

It has recently been reported that over 52,000 people across the UK have been denied NHS treatment for painful medical conditions such as varicose veins.

In healthcare, as in many areas of life, we are often told by 'the powers that be' that the best way forward is to mask over the visible cracks rather than to tackle the root of the problem head on, which is what I fear has happened in this instance.

Recently both private medical companies and NHS GP's have been denying patients immediate treatment for varicose veins and are instead insisting on a six-month trial of surgical support stockings to see if that improves their condition.

Unfortunately there is a public perception of varicose veins which labels them as purely cosmetic and relatively unimportant, rather than a serious health issue which requires due care and attention. So I have to say, I am not surprised that few people have sufficient knowledge of the condition to challenge a medical professional/insurer's advice to trial support stockings, rather than immediately seek a more effective form of treatment.

Over the last decade, our understanding of varicose veins has increased dramatically. The medical world is growing to understand that whilst varicose veins might be the visible lumpy veins bulging through the skin of the legs on standing, it's the underlying cause, the failure of the valves to pump the blood back to the heart during movement and stop the blood falling the wrong way down the veins with gravity during rest, that is the real root of the problem. It turns out that varicose veins are not the problem and rarely cause any harm at all - it is the underlying valve failure that causes medical difficulties.

The visible varicose veins are actually the good guys, protecting the leg from damage from the hidden varicose veins (venous reflux), and so treatment of these without treatment of the underlying problem would actually make the condition worse. The visible veins are an outward sign that the internal valves are failing and that the body has taken action to avoid damage. Those with "hidden varicose veins" are already getting that damage and see no outward signs until they start to experience aching, swelling, itching or visible skin changes starting around the ankle.

Treatment of all varicose veins depends upon identifying which valves have stopped working using a specialist ultrasound test called duplex ultrasound. Once identified, the underlying cause can be corrected using one of several cutting edge techniques - which so far have been proven to have excellent results in terms of both further deterioration and reversal of the damage caused. However, despite these strong results we are still seeing a worrying trend for private medical companies to refuse their patients claims for treatment unless they have previously trialled the seemingly useless support stockings for at least 6 months.

I find this very surprising considering that the application of pressure to the skin of the leg by support stockings has absolutely no effect in correcting the underlying problem of valve failure in the veins of the legs. This support can help reduce swelling or inflammation whilst the stockings are being worn, but as soon as they are removed the damage continues. I think it is also important to highlight that no research has been done to prove that medical support stockings in any way reverse or improve the underlying cause of varicose veins.

As the NHS and private medical insurance companies are always looking for "evidence-based medicine" it does confuse me as to why the same healthcare bodies are now recommending a treatment that has no research to back it up.

So, why are the private medical insurance companies and NHS recommending support stockings for varicose veins?

Well, to me the answer is rather obviously money! With somewhere in the region of 35-40% of the population suffering from venous conditions, those who hold the purse strings need to reduce the number of people having surgery to cure their problem due to the high costs of the treatment.

Personally, I think that insisting on six month trials of stockings is a very sneaky tactic. Within six months many will decide to fund themselves, move away (perhaps to another insurance provider) or may even die from something else. Not only does the six month trial reduce the number of patients that will eventually need to be funded for surgery, it also helps immediate cash flow by delaying any payment claim by six months. Yes this might be a good 'sticking plaster' for funders looking to save money, but for patients; it could ultimately come at a great price.

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