How patients are being left in agony as NHS cuts back on tonsil operations

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.

Many tonsillitis cases, the Rotherham team warned, end up needing ‘lengthy intensive care stays and a protracted course of rehabilitation’ (stock photo used)

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.

Tonsillectomies have dropped to just 40,000-50,000 a year in England, a fraction of the number at the peak (stock photo used)

MEDICAL JARGON BUSTER 

Scientific terms decoded. This week: Genome

The genome is the term for our entire set of genes. It is often what people mean when they refer to DNA.

Our DNA is the hereditary material that is unique to each of us.

The genome is often what people mean when they refer to DNA (stock image used)

Sections of DNA are known as genes, and act as different sets of instructions for building and maintaining our cells.

Our ‘genome’ refers to all these genes as a whole.

The term was first used in 1920 by a German botanist called Hans Winkler.

An international endeavour called the Human Genome Project was launched in 1990 to develop the technology and then analyse the human genome.

The project was completed in 2003, meaning that, for the first time, every human gene had been identified.

In the 1950s and 60s, around 250,000 patients a year underwent tonsil surgery in Britain.

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 40,000-50,000 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.

UNDER THE MICROSCOPE: Former Olympic figure skater and TV presenter Robin Cousins, 64, takes our health quiz

Robin Cousins, a former Olympic figure skater and TV presenter, pictured in 2018

Can you run up the stairs?

Yes I can, but certainly not at any great speed with my knees. The right knee will only bend to a certain point these days after however many knee injuries and surgeries.

My fitness regimen consists mainly of walking the dog [a nine-year-old French bulldog called Monty].

I like to walk. I’m along the coast from Brighton.

Get your five a day?

I try. I am mindful of my intake. At home, in my kitchen, I’ve got avocados, peppers, garlic, onions and carrots, and there are greens in the fridge.

Ever dieted?

No, but I’m probably carrying a few extra pounds. I weigh around 12st to 12st 6lb.

My height is probably starting to shrink slightly as I get older but I was 6ft tall. I was always the skinny string bean, as one reporter called me back in the day.

Any vices?

I don’t really count these as vices but I suppose I do enjoy a lovely gin and tonic and an occasional martini, or there’s wine and beer — but not all in the same night, I hasten to add. I’m also rather partial to Lindt chocolate.

Worst illness/accident?

About a year ago I had a run-in with some skin cancer — a mole, which has all been taken care of.

I suppose the most important one would have been the second knee surgery, aged 17 (I had a similar operation at 15, to remove torn cartilage) when the doctor said: ‘So what are you going to do if your career is over?’

And my answer, very bluntly, was: ‘It can’t be over because I haven’t had one yet.’

I had an osteotomy in the 2000s — basically where they straighten the leg and take the pressure off the knee joints.

I was incredibly bow-legged when I was skating and then I had cartilage surgery, but my knees have survived in a way that has allowed me to be on the ice.

I still get on the ice now, but do I jump and twirl? Absolutely not.

Robin Cousins writes: ‘I do enjoy a lovely gin and tonic and an occasional martini, or there’s wine and beer’ (stock photo used)

Pop any pills?

I take a multivitamin supplement for people over a certain age.

Cope well with pain?

I think I have a higher pain threshold than most and I think that comes from starting at a very young age to throw my body into the air while not necessarily knowing how it was going to come down.

Ever been depressed?

Upset, yes. Angry at myself over a performance that wasn’t up to par, or one that was really good that I didn’t get scored for properly.

But I can’t say I’ve ever known true depression.

Any phobias?

Grubs and creepy crawlies. I suppose the major one would be snakes.

Like to live for ever?

I suppose only if my loved ones and family were doing likewise. 

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