Case study: Breast Assessment in Nottingham

Background

In 1999 commissioners, consultants and patients in the mid trent region were all affected by the lack of a clear and equitable pathway for breast reduction. The problems led to a growing waiting list, inconsistency, poor use of resources and ultimately patient dissatisfaction. Dean Johnson formerly Director of Planning and Performance at Broxtowe and Hucknall PCT describes the situation well:
The previous lack of objective criteria led to a substantial backlog of patients on a growing waiting list. The new service provides us with an efficient and equitable method for assessing each patient's eligibility for surgery. The backlog has been cleared within a few months.

The solution

The Body Aspect team were consulted about the 3D body scanning technology and it's application to this field of exertise. A trial was conducted and criteria were agreed that took into account breast volume and torso volume.
Each patient is assessed against the same criteria and a report is provided to the PCT. The report includes breast volume but more importantly also computes the relative size of the breasts in relation to the thoracic region.
Following an Action On project which further looked into the pathway for breast reduction and breast asymmetry, in 2005 the modernisation agency produced guidelines "information for commissioners of plastic surgery" which incorporated the 3D Body Scanning pathway that was being used in Nottingham.

Results

As a result of using the Body Aspect system Nottingham PCT now finds that equity of access is assured. The system is also more dignified for, acceptable to and understandable by patients, with resources now targeted towards patients most in need.

Mr Mark Henley is a Consultant Plastic Surgeon and council member of both the British Association of Plastic Surgeons (BAPS) and the British Association of Aesthetic Plastic Surgeons (BAAPS). As he puts it:
The service provides a level of objectivity and equality of assessment not previously possible and removes the burden of deciding eligibility on the basis of breast size alone from the surgeon. The information made available can also assist in the planning of surgical procedures.

Conclusion

Innovative PCTs are adopting the Body Aspect system because it's better for patients and it's better for PCTs. As Dr Richard Richards, former Director of Public Health at Newark and Sherwood PCT, puts it:

This programme has resulted in more dignified and acceptable assessments that are easily understood by patients. There are significant cost reductions owing to the elimination of inappropriate referrals and resources can now be targeted to the patients that are most in need. This innovative technology should be present in hospitals nationwide.

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