South Yorkshire and Bassetlaw Integrated Care System denies patients access to many elective treatments

South Yorkshire and Bassetlaw Integrated Care System and the 6 constituent Accountable Care Providers/Integrated Care Providers in each local authority area are a poster child for Accountable Care (now re-branded by NHS England as Integrated Care).

Near the start of their recent Inquiry into Sustainability and Transformation Plans/Accountable Care, the House of Commons Health and Social Care Select Committee visited South Yorks and Bassetlaw Accountable Care System (as it then was – before NHS England rebranded Accountable Care as Integrated Care). They spoke about it in glowing terms at one of their hearings and it gets favourable mentions in their final Report.

But they didn’t mention the South Yorkshire and Bassetlaw Accountable Care System’s Commissioning for Outcomes policy, which is

“ designed to try to prevent any unnecessary use of NHS resources.”

This hinges on what you call “unnecessary.”

What they call preventing unnecessary use of NHS resources, we call restricting and denying patients’ access to NHS care

West Yorkshire and Harrogate Sustainability and Transformation Partnership (now Integrated Care System) has a similar scheme for restricting access to a range of elective care.

And now NHS England has decided to consult nationally for 12 weeks, starting July 4th, on:

“reducing the delivery of clinically ineffective interventions”.

This was on the agenda for the 4th July NHS England Board meeting.

NHS England notes that Clinical Commissioning Groups have already tried to restrict access to such NHS treatments –

“but they have told us that their efforts need to be better supported by the national statutory and professional bodies.”

The NHS England Board Paper for Item 4 ‘Developing the NHS Long Term Plan evidence based interventions‘ says they’ve received legal advice that they have a 13Q legal duty to consult on these changes.

So it’s disturbing that South Yorkshire and Bassetlaw Accountable Care System have imposed their similar ‘Commissioning for Outcomes’ Policy without any formal consultation. This means they did not comply with the 14Z2 legal duty to involve the public in commissioning decisions.

NHS England’s list of “clinically ineffective interventions” seems to pretty much duplicate what South Yorkshire and Bassetlaw Integrated Care System and West Yorks and Harrogate  Integrated Care System call “procedures of limited clinical value”.

Comments from patients who’ve had these interventions give the lie to NHS England’s claim that they’re clinically ineffective

If you or someone you know has a history of any of these conditions, please tell us about life pre- and post-op, and how it affected your quality of life.

In order to standardise the number of referrals from all GP practices and make one size fit all, South Yorkshire and Bassetlaw Integrated Care System’s ‘Commissioning For Outcomes’ policy introduces a system of managed GP referrals for so-called procedures of low clinical value.

The list of conditions that are subject to this control includes hernia, hip and knee operations, osteoarthritis, cataracts etc

To provide elective care for individual patients with these conditions, a GP has to find the time to fight for the patients and make an independent funding request to their Clinical Commissioning Group panel, if their patient needs treatment but doesn’t meet the standardised criteria.

Royal College of Surgeons senior vice-president Susan Hill said:

“Allowing commissioning groups, not patients with their surgeon, to make a decision to operate is putting patients at unnecessary risk of serious complications.”

Do they want to employ doctors or sheep? Because sheep will better follow algorithms that determine criteria for treatment

And why do they need criteria for treatment? If the criteria are reasonable, why are they necessary? Because that is surely what a GP would consider anyway when deciding whether or not to refer a patient for treatment.

And are there not likely to be valid reasons for different levels of referrals and treatment in different places? If so, what is this standardisation about?

The criteria for referral to treatment are grim – for a hip replacement, the patient needs to have intense or severe restrictions to meet the criteria: pain 3/4 of day and unable to self care -wash, dress, cook And pain on short distances of walking or when sat down. Well the patients will have to be hauling themselves around to find work in order to eat, so of course they all can move.

What is the point in specialism, if GPs can’t even refer for a specialist opinion without ticking boxes to warrant referral and if specialists are not qualified to decide if treatment is required & meets the risk/benefit mark?

What do they even mean by low clinical value? If a chap has an inguinal hernia and it only affects him 25% of his time I’m sure he is still going to appreciate the clinical value in regaining normal function – or is it ok to be good for nothing, once we’ve finished our 9-5 shift?

It is just another euphemism to hide that they are cutting costs and restricting access to care

These local and national policies bear out that the government and its quangos are intent on turning the NHS into a version of the USA’s Medicare/Medicaid system. This provides a limited range of health care, paid for by state funded insurance, for people who can’t afford private health insurance.

Restricting access to NHS services drives those who can afford it to go private, creating a two tier health service.

This is certainly the view of Spire Healthcare – a major chain of private hospitals in England. It expects a 10%/year increase in private patients

“as NHS waiting lists and rationing increase.”

At the same time, West Yorkshire and Harrogate Integrated Care System aims to cut a a range of elective care treatments by 10% in financial year 2018-19.

Updated 17 July with quote from Royal College of Surgeons senior vice-president Susan Hill.