RESTRICTED ELIGIBILITY?

NHS England delay 'denies patients access to life saving treatment' (HSJ: 25 July 2017)

Patients are being denied access to heart treatments that could prevent strokes or save lives, after an NHS England project was delayed, a charity has told HSJ.

NHS England’s Commissioning Through Evaluation programme enables limited numbers of patients to receive treatment that shows “significant promise” but is not currently funded by the NHS.

Left atrial appendage occlusion (LAAO), which could reduce strokes in people with atrial fibrillation, is one of the CTE projects under consideration.

Patent foramen ovale (PFO) closure, aimed at preventing recurrent strokes and improving survival rates, and percutaneous mitral valve leaflet repair for mitral regurgitation (MitraClip) used to treat patients with heart failure and prevent the need for open heart surgery, are also part of the CTE scheme.

However, NHS England is warning patient groups and charities of a two month delay in evaluating data, making “a knock on effect” on future commissioning decisions possible.

A charity representing people with abnormal heart rhythms believes the delay will deny high risk patients access to treatment that could prevent AF related strokes or even save lives.

The Arrhythmia Alliance and AF Association said LAAO already has approval in the US and has written to NHS England expressing concern over the delay... read more

 

HPV vaccine: anger over decision not to extend NHS scheme to boys (19 July 2017)

A decision not to vaccinate boys against a cancer-causing sexually transmitted infection has been condemned by health bodies and campaigners.

The Joint Committee on Vaccination and Immunisation (JCVI), which has been reviewing the human papilloma virus (HPV) vaccination programme, concluded that it was “highly unlikely to be cost-effective” to extend the scheme to include adolescent boys as well as girls.

Since 2008, all girls aged 12 to 13 are offered the HPV vaccination as part of the NHS childhood vaccination programme, and the JCVI has been considering whether to include boys on the scheme since 2014.

Up to eight out of 10 people will be infected with the virus at some point in their lives and it has been linked to one in 20 cases of cancer in the UK, according to health professionals. Campaigners have been calling for a gender-neutral approach to the vaccination, which would ensure that 400,000 school-age boys are not left at risk.

The committee, which has yet to publish its final recommendation, said in an interim statement that studies “consistently show” boys are afforded “considerable herd protection” when there is high uptake of the vaccine in girls.

Critics called the decision “indefensible”. The Faculty of Sexual and Reproductive Healthcare (FSRH), a membership body for healthcare professionals who work in sexual and reproductive health, said the decision should be reversed when the JCVI meets again in October.... read more

 

Doctors forced to plead with NHS for treatments for patients, BMJ finds (The Guardian: 5 July 2017)

Growing rationing of healthcare is forcing more doctors to plead with the NHS to fund treatments patients need, including cataract removals, new hips and knees, and removal of varicose veins.

GPs and hospital consultants in England submitted 73,927 exceptional requests on behalf of patients in 2016-17 in a bid to persuade the NHS to fund drugs or surgery they were initially denied, an investigation by the BMJ has found. That was almost 50% more than the 50,188 individual funding requests (IFRs) doctors put in to clinical commissioning groups (CCGs), the bodies that hold the NHS budget in local areas, in 2013-14.

The revelations have prompted fresh concern among doctors and health experts that the cash-strapped NHS is increasingly denying patients treatments that were routinely available until recently. The sick “have misguidedly become soft targets for NHS savings”, the Royal College of Surgeons (RCS) has said.

The BMJ’s findings are based on freedom of information requests sent to England’s 207 CCGs, of which 192 responded. Just over 50,000 IFRs were submitted in both 2013-14 and 2014-15. But that suddently rose by almost 20% to 60,425 in 2015-16 and then by about a fifth yet again to last year’s total of 73,927.

The commonest reason for an IFR last year was for surgery to remove unsightly skin, such as skin tags. Doctors did that on behalf of 6,079 patients.

The next most common after that were: cosmetic and aesthetic surgery (4,426 IFRs), plastic surgery (1,889) and fertility treatment (1,151).

Mental health conditions were the sixth commonest reason for a request. Despite the NHS’s pledge to improve access to care, doctors still had to submit an IFR to try to get 1,150 patients what they judged to be the care they needed....read more

 

Pain-level rationing of hip and knee surgery due to cash crisis, admits NHS (The Guardian : 27 January 2017)

A senior NHS official has admitted that funding shortages mean hip and knee replacements will have to be rationed according to pain levels in some parts of the country.

Three clinical commissioning groups (CCGs) in the West Midlands have proposed reducing the number of people who qualify for hip replacements by 12%, and knee replacements by 19%. To qualify under the proposed rules, patients would need to have such severe levels of pain that they could not sleep or carry out daily tasks.

Julie Wood, the chief executive of the NHS Clinical Commissioners, said the proposal was a response to financial pressures.

“Clearly the NHS doesn’t have unlimited resources,” she told BBC Radio 4’s Today programe. “And it has to ensure that patients get the best possible care against a backdrop of spiralling demand and increasing financial pressures.”

She admitted that decisions on hip and knee replacements “will vary in different parts of the country”, amid reports that other areas were already using pain levels to ration such operations...read more

 

A fifth of new medicines could be rationed under NHS cost-cutting effort - even if they've been ruled effective (The Daily Mail : 19 January 2017)

Cancer and diabetes sufferers are among those who will be forced to wait for new drugs as part of an NHS cost-cutting exercise.

A fifth of new medicines could be rationed by health bosses - even if they are judged to be cost-effective by doctors.

Currently, patients are entitled to medicines that are considered to be good value for money by the National Institute for Health and Care Excellence (Nice).

However, from April this year, NHS England will have the power to delay the availability of new drugs that cost upwards of £20million a year.

According to The Times, as much as 20 per cent of new medicines - or roughly 12 a year - would fall into this bracket.

The move has been heavily criticised by health campaigners, claiming people will die waiting for treatments that are not being provided for strictly economic reasons.

They also pointed to fears that Britain will fall behind the rest of the developed world in providing 'cutting-edge' treatments.

It comes amid growing political tension regarding the NHS, with doctors accusing Theresa May of making GPs scapegoats to divert attention from the crisis…read more

 

Young homeless people 'falling through the cracks' in mental health care, charity warns (The Guardian: 6 December 2016)

Centrepoint describes a postcode lottery for 16 to 24-year-olds traumatised by mental illness or their experiences with homelessness

Vulnerable young homeless people are falling between the cracks in mental health provision because it is still regarded as a “Cinderella service”, the youth homelessness charity Centrepoint has warned.

Stamatia Lorentzou, Centrepoint’s Clinical Lead, said that while those with “the common mental health conditions” usually got help, others with medium and low-level needs faced something akin to a postcode lottery.

The losers, she said, included not just 16 to 24-year-olds whose problems contributed to them being homeless, but also youngsters traumatised by the experience of homelessness itself, even though it might have been caused by factors other than mental health, like family breakdown....Read More.

 

Talks begin on cutting NHS IVF funding in parts of Nottinghamshire (Notts Tv: 5 December 2016)

Health bosses are meeting the public today to discuss plans which could see NHS funding for IVF treatment scrapped in parts of Notts.

Members of NHS Mansfield and Ashfield and Newark and Sherwood Clinical Commissioning Groups (CCGs) are consulting on the proposals before a final decision is made in January.

Several options being reviewed include changing the eligibility criteria for access to IVF treatment funded by the NHS, and withdrawing it altogether.

The CCGs currently fund one cycle of IVF per person in both areas, although people sometimes pay privately for additional cycles if required.

Funding of IVF in Newark and Sherwood and Mansfield and Ashfield currently costs around £300,000 per year.

It was announced in August that the NHS needs to cover a shortfall of around £20m in the area.

Chief officer for NHS Newark and Sherwood and Mansfield and Ashfield CCGs, Dr Amanda Sullivan said: “The local NHS has been very successful in treating more conditions and in helping people to live longer.

“Additional funding has been made available to the NHS, but new treatments, growing levels of long-term conditions and increasing expectations mean that CCGs now have to re-prioritise how precious NHS resources are deployed…(read more)

 

NHS patients told to lose weight and quit smoking or face operation delays (The Guardian: 29 November 2016)

 Obese people and smokers will be asked to lose weight and give up cigarettes or face delays to routine operations after a health authority’s proposals were approved byNHS England.

Patients with a body mass index (BMI) of at least 30 will be asked to lose weight or face a 12-month delay for elective surgery while smokers will be asked to quit for two months or face a six-month postponement, the Vale of York Clinical Commissioning Group (CCG) announced.

The NorthYorkshire CCG ruled out a “blanket” ban and said each patient would be dealt with on a “case-by-case basis” when the plan comes into force in January.

The CCG said: “Smokers and obese patients that need routine surgery, but do not wish to access the support services or fail to meet the criteria will not be denied their operation, but it could mean they have to wait longer than they otherwise would have done.”...read more

 

Hospitals may require patients to show passports for NHS treatment (The Guardian: 21 November 2016)

Patients could be told to bring two forms of identification including a passport to hospital to prove they are eligible for free treatment under new rules to stop so-called health tourism.

The most senior official in the Department of Health told MPs on Monday that he was looking at making hospitals check patients’ papers to find out whether they should be paying, a proposal he admitted was “controversial”.

It would mean that those trying to access health services in England, including British citizens, might have to prove their identity before having operations and undergoing tests in hospitals, but it would not cover care received at GP surgeries.

Chris Wormald, the department’s permanent secretary, told the public accounts committee that passport checks were already taking place at one hospital in Peterborough which services a population with a high number of immigrants.

Wormald said: “On the general question of are we looking at whether trusts should proactively ask people to prove their identity – yes we are looking at that…(read more)

 

NHS rationing set to worsen in attempt to close £22bn funding gap (www.telegraph.co.uk: 5th August 2016)

NHS treatments will need to be rationed and hospitals closed unless the health service makes unprecedented efficiency savings, a leading think-tank has said.

The warning from the Nuffield Trust comes amid increasing restrictions on cataract surgery, hip and knee operations, and rationing of treatment for children with cystic fibrosis.

The think tank said hospitals would have to achieve twice the level of efficiencies achieved in recent years, to have any hope of closing a £22 billion funding gap by 2020.

Author Sally Gainsbury said attempts to squeeze more out of the NHS meant hospitals were being paid 20 per cent less in real-terms to carry out operations than they were six years ago.

“The report is damning. It’s a very serious warning that we could see a rationing of health services if the financial crisis in the NHS is not addressed”...Read More

 

Can the NHS really not afford second transplants for cancer patients like me? - Hannah Partos (The Guardian: 28 July 2016)

If I had not been given a stem cell transplant, I would be dead by now. At 22, I was diagnosed with acute lymphoblastic leukaemia, an aggressive form of blood cancer. Doctors told me a transplant of healthy stem cells from an unrelated donor was my only hope. Last month, I was thrilled to celebrate three years in remission. I hope the cancer never returns, but if it does, my only chance of survival will be another transplant. Except this time around, I might not be given that chance.

Two weeks ago, NHS England announced it would stop routinely funding second stem cell transplants for patients who have relapsed more than a year after their first transplant. NHS England, the body which oversees the budget for commissioning NHS services, has ruled that the treatment is “not currently affordable”, even though it was widely available in England before 2013, and is routinely given to patients in Europe and the US.

In a letter to The Times Anthony Nolan, the blood cancer charity and stem cell registry that coordinates all donors for UK transplants, joined forces with leading haematologists to condemn the decision, stating that “NHS England is ignoring the advice of the clinical community, thereby effectively handing [most of these] patients a death sentence”. The charity delivered an open letter with 18,000 signatures to Jeremy Hunt last Thursday, calling on him to urge NHS England to reconsider their decision....read more

 

CCGs consider sweeping restrictions to plug £25m hole (HSJ: 21 March 2016)

A group of clinical commissioning groups in the Midlands have outlined proposals for wide ranging restrictions to NHS services in order to close a £25m funding gap.

The ideas include restricting access to knee and hip operations, no longer providing hearing aids for people with mild hearing loss, and restricting access to some treatments “for patients who have unhealthy lifestyles”.

Redditch and Bromsgrove, South Worcestershire and Wyre Forest CCGs said they would spend £25m more than their combined budgets in 2016-17 if they did not make changes.

The CCGs said they needed to “find ways of reducing costs in some areas… to protect other essential services”.

The groups are carrying out a survey of the changes they are considering, but stressed they were “just ideas” and no decisions had yet been made...read more

 

NHS to begin denying people hearing aids for first time (The Guardian: 1 October 2015)

The NHS will start denying people with hearing problems access to hearing aids for the first time from Thursday in a controversial move that critics claim will worsen sufferers’ social isolation. The GP-led NHS clinical commissioning group in North Staffordshire is taking the unprecedented step of ceasing to provide free hearing aids to mainly elderly people in its area with mild hearing loss.

It is also making it harder for those with moderate hearing loss to get access to hearing aids by introducing new eligibility criteria against which patients will be judged.

Campaigners and hearing experts have criticised the new policy as “ill thought-through, baffling and unprecedented”.

The CCG says the new restrictions are necessary to help it save money, and will save it about £200,000 in the first year. But the charity Action on Hearing Loss claims that hearing aids cost the NHS as little as £90 each. The CCG estimates that its new policy will lead to about 500 people a year no longer getting a hearing aid to help mitigate the decline in their hearing capacity, which sufferers say damages their quality of life. They will now have to decide whether to pay the much higher prices charged by high street providers, which can charge many thousands of pounds...read more

 

GPs face increasing restrictions as NHS rations care to save money (Pulse: 30 July 2015)

GPs face increasingly tighter restrictions on their ability to refer for specialist care, reveals an investigation by Pulse into plans drawn up by the most cash-strapped CCGs in the country.

The investigation reveals that CCGs are introducing policies that cap surgical referrals, require overweight patients to go a on a ‘weight loss programmes’ before an operation and deny hard-of-hearing patients hearing aids and audiological care.

The investigation comes as GPs say they are finding it harder to refer for surgical treatment of conditions like ganglions or carpal tunnel and, in one area, requests for hysterectomies are simply being ‘fobbed off with a Mirena coil’.

More than a third (36%) of GPs told Pulse they are facing new constraints on services to which they were previously able to refer.

The investigation comes as the health service prepares to implement £22bn of efficiency savings by 2020. But only two years after coming into existence, 19 CCGs have been ordered by NHS England to devise emergency plans to cut their budget deficits.... Read more

 

Eating disorder patients' lives at risk due to long waits for NHS treatment (14 June 2015: Guardian)

The lives of people seriously ill with eating disorders are being put at risk because they have to wait up to three years for NHS treatment.

Experts warn that specialist services are struggling to cope with a growing caseload and are so overstretched they have to prioritise patients with anorexia, because they are at greatest risk, ahead of those with bulimia – even though their condition is seriously affecting their lives.

Patients forced to endure long delays are at greater risk of serious damage to their health because it deteriorates while they are waiting. They also have a smaller chance of making a full recovery.

 

Obese patients denied surgery by NHS rationing (10 June 2015: GP)

GP leaders slammed the ‘rationing’ of NHS services and warned that the restrictions on access to care appeared to breach the NHS Constitution.

NHS England’s national commissioning criteria for bariatric surgery could prevent GPs from referring patients for bariatric surgery in line with NICE guidance.

The NICE clinical guideline Obesity: Identification, assessment and management of overweight and obesity in children, young people and adults was issued in November 2014.

It recommends bariatric surgery as a treatment option for patients with obesity if they ‘have a BMI of 40kg/m2 or more’ or a BMI ‘between 35kg/m2 and 40kg/m2 and other significant disease’.

It adds that ‘all appropriate non-surgical measures have been tried’ and the patient ‘has been receiving or will receive’ intensive management in a 'tier three' service.

The NICE guidance does not impose any time restrictions on access to care.

But NHS England’s commissioning policy stipulates that the patient must have ‘received and complied’ with a tier three or four weight-loss management service ‘for a duration of 12-24 months’ in order to qualify for bariatric surgery.

It also dictates that the patient must have been morbidly obese – BMI 40 or higher – ‘for at least five years’ to be eligible for the potentially lifesaving treatment.... Read more

 

NHS to 'extend rationing' of healthcare in bid to balance books (The Guardian: 21 April 2015)

The NHS plans to dramatically increase rationing of patients’ access to care and treatment in an effort to balance its books, a new survey of health bosses reveals.

Almost two in five of England’s 211 clinical commissioning groups (CCGs) are considering imposing new limits this year on eligibility for services such as IVF, footcare and hip and knee replacements.

Smokers and those who are obese will be among those denied surgery and other treatment, according to a survey of 80 CCG leaders conducted by the Health Service Journal, in an extension of the controversial policy of “lifestyle rationing”.

Chief executives, chairs and board members at 67 CCGs were asked: “Is your CCG considering introducing new limits to access/eligibility for services during 2015/16, for financial/efficiency/value reasons?”. Among the respondents, 39% said yes, 57% said no and 4% did not know.... Read more

 

Free hearing aids given out by NHS to be ‘rationed’ (16 March 2015: Express)

North Staffordshire health chiefs have decided that those with “mild or moderate” hearing problems will no longer receive free hearing aids from September.

They said it would only affect about 500 patients a year.

Deafness charities claim up to 37,000 in the region suffer from mild or moderate hearing loss.

Some will still qualify for free hearing aids but only after meeting the new, tougher requirements.

Paul Breckell, of Action on Hearing Loss, said some people will be denied hearing aids while others “three streets away” will still get them.

He said: “How can health bosses, in good conscience, deny patients the lifeline that hearing aids provide?”

Public health concerns mount as 'personal health budgets' imposed on 10,000 chronically ill patients.... Read more

 

CCGs starting to ration hearing aids in order to cut costs (The Guardian: 3 January 2015)

Campaigners are accusing the NHS of imposing “cruel” cuts on people who are going deaf by denying them the hearing aids they need. Growing numbers of NHS organisations are planning to ration access to the devices, even though they help to combat dementia, depression and social isolation among the hard of hearing.

Three of England’s 211 GP-led local clinical commissioning groups (CCGs), which fund treatments, are already facing heavy criticism after announcing they intend to restrict the numbers of hearing aids in order to save money.

The Northern, Eastern and Western Devon CCG has decided to provide only one hearing aid to those who have hearing loss in both ears, even though they need two. And CCGs in North Staffordshire and Kernow in Cornwall are introducing eligibility criteria that will deny hearing aids to those with mild to moderate hearing loss.

New research shows that 22 other CCGs either plan to follow suit or are considering making changes to their audiology services that could hit the hearing-impaired.... Read more

 

A&E should turn away minor problems (Belfast Telegraph: 26 June 2014)

The NHS should consider refusing to treat patients who turn up at A&E with minor problems, a group of MPs and peers have said.

The controversial move should be looked at alongside a wider education drive to help people manage their own health issues better.

The suggestion comes in a report from the All-Party Parliamentary Group on Primary Care and Public Health, co-chaired by Tory MP Nick de Bois and Labour's Kevin Barron...read more

 

People with diabetes 'still denied vital prescriptions' (BBC News: 19 November 2014)

Patients with diabetes are missing out on vital prescriptions that let them keep tabs on their condition, despite repeated warnings, says Diabetes UK.

Its poll of 1,300 patients found nearly half had had prescriptions for blood-testing strips refused or restricted.

The Department of Health has previously written to GPs reminding them not to restrict access to this kit other than for clinical reasons.

Doctors say there is a balance to be struck with protecting NHS resources.

Diabetics must know their blood-sugar reading to stop it going dangerously high or low...read more

 

MPs warn on kidney dialysis plan (Yahoo News: 20 November 2014)

Kidney disease charities were "stunned" to have been told this week dialysis will no longer be a prescribed service on the English NHS from next year, MPs have heard.

Labour's Madeleine Moon (Bridgend) said officials at the Department of Health revealed the "dangerous" decision in a meeting, and told the groups legislation would be put to MPs in February.

Mrs Moon urged Commons Leader William Hague organise a ministerial statement by Health Secretary Jeremy Hunt to allow MPs to protest at the plans.

Speaking during the weekly business statement, she said: "At a meeting in the Department of Health this week, kidney charities were stunned to be told that kidney dialysis was no longer to be a prescribed service and a period of consultation of six weeks would be held by the Department of Health.

"And then a Bill would be introduced to Parliament during February and changes to CCG (clinical commission groups) commissioning will commence on April 1... Read more

 

“Need not cost to determine routine surgery” (Hospital Doctor: 13 November 2014)

A royal college has called on NHS England to investigate a CCG which is proposing to limit access to surgical services.

Devon CCG has said it will deny routine surgery to smokers and the morbidly obese unless they quit or lose weight.

The GP-led Northern, Eastern and Western Devon Clinical Commissioning Group says the measures are “urgent and necessary” as it faces a £14.5m deficit and needs to reduce costs.

However, Miss Clare Marx, president of the Royal College of Surgeons, said: “Access to routine surgery should always be based on an individual’s clinical need.

“The government has been clear that restricting clinically necessary treatment on the basis of financial considerations is unacceptable. We urge the Department of Health and NHS England to review the situation in Devon if the CCG is indeed intending to deny patients treatment without enabling the clinicians and patients involved to make informed choices about their care.”

Rebecca Harriott, the Devon CCG chief officer, said it would be prioritising services in the NHS Constitution.

The group says hernia treatment, botox injections and cataract operations are also under review.... Read more

 

Health chiefs block plan by ministers which could force NHS to discriminate against jobless and elderly (Daily Mirror: 18 February 2014)

A shocking proposal that could force the NHS to discriminate against the jobless and elderly has been blocked by health chiefs. They rejected a plan by ministers to look at “benefit to society” when deciding who gets new drugs. Sir Andrew Dillon, head of drugs control body Nice, fears the policy could see younger patients with jobs go to the front of the queue.

“We’re really concerned that we don’t send out the message that we value life less when you’re 70 than we do when you’re 20,” he said. A health department official yesterday insisted the move was to get good value for money. A spokesman for David Cameron said age discrimination was already banned in the NHS... Read more

 

73% of health trusts won't fund full IVF: Thousands of women being denied treatment because of rules to save money (Daily Mail: 23 January 2014)

Thousands of women are being denied fertility treatment because health trusts are imposing ‘unfair’ rules to save money, a report warns today. Six have stopped paying for IVF altogether. Three quarters are refusing to offer women at least three courses of treatment, as set out in official guidelines, because it is too expensive. Most will not fund treatments for women if their partners smoke, are obese, drink too much or have children from a previous relationship. Heartbroken couples say this postcode lottery has ‘devastated their lives’ and means many will be unable to have children because they cannot afford private treatment. More than half of clinical commissioning groups will not offer IVF to couples if one already has a child from a  previous relationship, even though this is not a stipulation in the NICE guidelines. And many CCGs will not  provide the treatment to couples if one of them smokes, drinks even a moderate amount of alcohol or is obese... Read more

 

Islington Council first to oppose controversial health firm Atos (Islington Gazette: 18 October 2013)

The town hall has become the first in the UK to officially oppose a controversial healthcare company it says brings unnecessary suffering to thousands of disabled people. Islington Council’s ruling executive last night passed a vote of no confidence in French firm Atos who are responsible for assessing whether people are eligible for disability benefits on behalf of the Department for Work and Pensions (DWP). The DWP are trying to slash their bill by 20 per cent, and Atos have been criticised for assessing people as fit to work even if they are very ill – in Islington the council helped a whopping 90 per cent of people successfully appeal against the company’s decision.

Cllr Richard Watts, leader of Islington Council, said: “Disabled residents deserve far better than this over-reliance on dangerously simplistic computer questionnaires.“Atos’s performance in Islington has been shocking and we are telling the Government we no longer have any confidence in them."... read more

 

Watchdog warns NHS is rationing treatment (Financial Times: 22 March 2013)

The NHS is rationing treatments as it seeks to curb demand for its services and deliver big cash savings, a Commons spending watchdog has warned.

Following an inquiry into how much progress the health service has made towards its target of £20bn in efficiency savings by 2014-15, the public accounts committee also accuses the health department of producing “unreliable” data about how much money has actually been recouped and says only 60 per cent of the claimed reductions can be substantiated.

Expressing concerns that the NHS is limiting access to certain kinds of treatment, such as cataract operations, bariatric weight-loss surgery and hip and knee replacements, the MPs acknowledge that the organisations in charge of buying care for patients have to make choices and set priorities in the face of rising pressure on services.

However, they say that patient groups as well as professional bodies view eligibility criteria for access to services as “arbitrary and inconsistent”. Margaret Hodge, who chairs the committee, said: “These procedures are described as being ‘of low clinical value’, but people waiting for these operations suffer pain and a poorer quality of life.”... read more

 

BMJ investigation finds GPs being forced to ration access to hospital care (Science Codex: 10 July 2013)

A British Medical Journal investigation has found that some CCGs have tightened the thresholds for access to "low priority" surgery such as hernia and joint problems, while others have introduced new systems to restrict the flow of patients being sent to hospital. The investigation also found that only four of England's 211 new GP led organisations, which assumed statutory responsibility for commissioning around £60bn of NHS care on 1 April 2013, have adopted new guidelines to help widen access to IVF treatment. This has led to disparities in availability across England.

A few CCGs have removed referral restrictions and are relying on better communication between primary and secondary care doctors to drive down costs, but this investigation has reopened the debate about the role doctors are playing in rationing care in the new NHS - and how this conflicts with their role as patient advocates. It also raises the question of whether the government, in collaboration with the medical profession and the public, should draw up a list of core services for the NHS to avoid a postcode lottery.

CCG leaders told the BMJ that all changes and new policies on whether to refer patients were primarily driven by clinical evidence and best practice and not by finance. NHS England also said it had a process in place to ensure that CCGs delivered their "statutory duties in relation to quality of services."...read more

 

More than half of NHS trusts rationing treatments (The Telegraph: 13 December 2012)

A report by the National Audit Office has found that some 56% of primary care trust clusters have either introduced or tightened criteria determining which patients are eligible for at least one type of common operation. Hospitals in certain areas have stopped offering elective treatments for smokers or people above a certain level of obesity, while in others cataract patients are being forced to wait until their eyesight deteriorates further before being allowed surgery. Rationing elective operations "essentially defers, rather than avoids, spending", the report said, which noted that the health service “is making increased use of demand management measures to reduce the growth in hospital activity”.The NAO called for senior NHS civil servants to introduce a national framework to prevent patients in some areas being subjected to tough new rules on qualifying for treatment while those in others are not.... read more

 

How can GPs discuss treatment outside the NHS with patients? (The Guardian: 21 November 2012)

Longer waiting times and restricted procedures mean that more patients are opting to pay for treatment or care themselves, but healthcare professionals say discussions on 'self pay' are difficult.

Patients and doctors are increasingly talking about the options for certain procedures outside the NHS, despite GPs still finding it difficult to raise the issue.

While an increase in online resources has meant more savvy patients, more than half of doctors attributed the increase to longer waiting times and patients not fitting the eligibility criteria for certain restricted procedures, which is individually determined by primary care trusts (PCTs). Cataract operations and hip and knee replacements are among procedures often classed as "non-urgent" or "cosmetic" and rationed in a drive to save money. In June it was revealed that limits on cataract surgery were in place at 66% of trusts in England and more than a half were rationing hip and knee and weight loss surgery. Around 70% of GPs in the BMI Healthcare survey said they were unable to refer patients because of PCT criteria issues at least once a month, whilst in some regions this rose as high as 82%. Nearly a quarter said they encountered this on a weekly basis... read more

 

NHS rationing is putting health at risk, says doctors' leader (The Guardian: 31 August 2012)

Mark Porter, the new British Medical Association's chair of council, says that the NHS is putting patients' health at risk by denying them drugs and operations because of growing rationing being imposed to save money. The drive to meet demanding efficiency targets is so serious that the NHS is offering some GPs surgeries extra money if they send fewer patients for tests and treatment in hospital — a move condemned as "morally wrong" by Dr Porter.


The NHS has come under growing criticism for making it harder for patients to have operations for routine conditions such as hernia, cataracts, grommets, wisdom teeth, or hip or knee replacement, and denying infertile couples IVF. Rationing of access to certain procedures deemed not worthwhile by the NHS will soon become much more widespread as the spending squeeze in the service tightens, said Porter: "You see it happening in examples now, but it's when it becomes service-wide in a few years' time, if the current policies continue, that the population will notice in the wider sense."... read more

 

Exclusive: 90% of PCTs are now rationing care (GP Online: 19 June 2012)

More than 90% of PCTs impose thresholds or limits on referrals for procedures deemed 'non-urgent' or of 'low clinical value', a GP investigation shows.

The findings reveal that use of the limits, which can deny patients treatment until their conditions deteriorate beyond NICE thresholds, have risen since a similar GP investigation last year. GPs and charities accused PCTs of 'introducing waiting lists by the back door' by limiting access to care.

Of 101 PCTs responding to a Freedom of Information Act request, 91% had measures in place to limit GP referrals for such procedures for 2012/13. Limits on cataract surgery are in place in 66% of trusts, while 59% restrict bariatric surgery and 59% limit joint surgery.

For cataracts, some PCTs will only fund surgery for one eye and some restrict bariatric surgery to patients with BMI over 50. NICE says bariatric surgery should be offered to patients with BMI over 40.

Kent GP Dr Julian Spinks said PCTs were restricting treatments that would be needed 'sooner or later'.

'They're introducing waiting lists by the back door,' he said. 'People are not getting treatment or having to wait until they get worse, but the government and the NHS can say they're meeting targets.'... read more

 

Patients denied treatment as NHS makes cutbacks, Telegraph can disclose (The Telegraph: 17 December 2010)

Hundreds of thousands of NHS patients are being denied routine procedures as dozens of trusts cut back on surgery, scans and other treatments in order to save money, a Daily Telegraph investigation has found.

Trusts around the country are refusing to pay for operations ranging from hip replacements, to cataract removal and wisdom tooth extraction. The health service is also tightening restrictions that prevent patients undergoing procedures for lifestyle reasons. Smokers and obese patients are being denied operations until they change their habits and trusts are delaying surgery and non-emergency treatments, the Telegraph has found in the most comprehensive snapshot of NHS cuts yet.... read more

                                                                                                                                                                     

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