Varicose Veins and the NHS: All You Need To Know

Varicose veins are a common condition that affects many people in the UK. The National Institute for Health and Care Excellence estimates that around a third of the population in the UK will be affected by “visible varicose veins in the lower limbs.”

Even though they might not be visible at first, varicose veins can significantly worsen once symptoms become evident. Varicose veins are an early indicator of vein disease; a progressive disease that can lead to skin discolouration, haemorrhage (bleeding), thrombosis (blood clots), venous ulcers, and even pulmonary embolism. 

Symptoms of varicose veins include throbbing pain, itching, restless legs, and heaviness. Some factors can make someone more prone to varicose veins, such as genetic and other health predispositions, gender, age, or the leading of a sedentary lifestyle.

While treatment is increasingly restricted, the NHS will provide treatment in certain circumstances. This article discusses all you need to know about the NHS criteria for varicose vein treatment.

Treatment Restricted on the NHS‍

The NHS defines varicose veins as “swollen or enlarged veins.” To qualify for treatment under the NHS, a patient needs approval from their Clinical Commissioning Group (CCG). CCGs were established in 2013 and organise the delivery of NHS services in different parts of England.

Despite their prevalence and the progressively serious complications they can cause if left untreated, only the more advanced forms of varicose veins are typically covered by the NHS. And there are many factors that are considered when deciding who can be treated.

In 2007, the NHS started restricting access to varicose vein treatments like ablation and sclerotherapy. In 2012, access was then further restricted, and cases are now assessed against new criteria to decide whether treatment is essential, important or low-priority.‍

Who is Eligible for Varicose Vein Treatment on the NHS?‍

In order to assess whether a patient is eligible, the CEAP scale is used. The CEAP classification (Clinical-Etiological-Anatomical-Pathophysiological) was created to standardise the different categories of chronic venous disease.

Patients are ranked from Grades 1 to 6, based on increasing levels of severity. ‍

Grades 1 and 2 are considered mainly cosmetic and are ineligible for treatment under the NHS.‍

Grade 3 is when patients report pain and discomfort, including throbbing, leg swelling and soreness. Grade 3 patients used to be eligible for treatment under the NHS, but they are now often only advised to use compression socks.‍

Grades 4-6 can all usually be considered for treatment by the NHS. Treatment offered may be superficial in the form of drugs and dressings, with surgical interventions dealing with the underlying cause of vein disease (such as endovenous ablation) reserved for the severest of cases:‍

Grade 4 is when varicose veins develop complications like phlebitis or venous eczema. ‍

Grade 5 is when the varicose veins cause severe skin damage, usually showing up as discolouration.‍

Grade 6 is when venous ulcers begin to develop. This can cause tremendous pain, and is difficult to heal.

While compression socks are often recommended for those who are in the early stages of vein disease, it’s important to note that, while they help manage varicose veins, they are not a substitute for treatment.‍

Worst Case Scenarios

As you can see, it is often difficult to get varicose veins treated on the NHS until the patient reaches a moderately advanced stage. 

As previously stated, varicose veins are a warning sign of vein disease, which is a progressive condition that can result in skin discolouration, bleeding, thrombosis (blood clots), venous ulcers, and even pulmonary embolism in some cases. 

Varicose veins are characterised by throbbing pain, itching, restless legs, and heaviness in the legs and ankles. It is possible to experience more concerning side effects such as discolouration of the skin, excruciating pain, and, in severe cases, venous ulcers or deep vein thrombosis. 

There are several factors that can increase a person's risk for varicose veins, including genetic and other health predispositions, gender, age, and leading a sedentary lifestyle (for example, smoking).‍

Fortunately, there are other options‍

If you think you are in the early stages of vein disease, you can choose to seek an appointment with a private medical provider such as the UK Vein Clinic on Harley Street in London. 

Our treatment pathway follows the gold standard set out by NICE (National Institute of Clinical Excellence) which requires a vascular ultrasound scan performed by a vascular scientist. Once we have mapped your venous system in detail, we will provide objective advice on treatment options to become varicose vein free. 

These are normally endovenous radiofrequency ablation or foam sclerotherapy. If you choose to have treatment, you may even find that you can walk in and walk out on the same day, with minimal interference to your daily activities.

We first help you understand the stage of your varicose veins and then offer objective advice on the treatment options that you may take to become varicose vein free. If you have private medical insurance, we can help you understand if you are covered for the treatment cost. If you do not have this insurance, we may offer a 6 or 10 month payment plan; you can see our pricing page for more information.