Doctors to be stopped from referring patients for many elective treatments in drive to cut £200m/year

The quango NHS England wants doctors to “reduce the delivery” of 17 elective care treatments that it says are “clinically ineffective.” It is running a 3 month national consultation on this, starting July 4th.

(More info about the consultation, CK999’s response etc, here.)

These treatments range from snoring surgery, through injections for nonspecific back pain without sciatica, to tonsillectomy for recurrent tonsilitis, carpal tunnel and Dupuytren’s surgery.

NHS England’s legal advice is that they have to ensure appropriate public engagement under Section 13Q of the NHS Act 2006.

They call this the Evidence-Based Interventions policy. It was on the agenda for the 4th July NHS England Board meeting. The paper for the meeting says that
in “financially challenged systems”  (are there any that aren’t?) -“accelerated progress” on stopping provision of these treatments will be “an integral part of recovery plans”.

Calling these treatments “clinically ineffective” is just another euphemism to hide that NHS England are cutting costs and restricting access to care

The government and its NHS quangos are bent on turning the NHS into a version of the USA’s Medicare/Medicaid, which provides a limited range of healthcare paid for by state-funded insurance for people who can’t afford private health insurance.

Restricting and denying patients’ access to NHS elective (planned) care will create a two tier health care system where those who can afford to, go private.

Earlier in the year, Spire Private Hospitals thought they are going to do well out of this, through the “self pay market” increasing as a result of NHS restrictions to elective surgery.

Update 15 August. But now they think their NHS share will not “hold” but will decrease as NHS cuts elective orthopoedic surgery. They have issued a profit warning, but expect the private market to recover.

Sustainability Transformation Partnerships, individual Clinical Commissioning Groups and Integrated Care Systems have already been restricting patients’ access to elective care.

You can read about the related South Yorkshire and Bassetlaw Integrated Care System’s “commissioning for outcomes” policy here  and West Yorkshire and Harrogate Integrated Care System’s restrictions to elective care here and here.

These “demand management” schemes have been driven by the aim of cutting costs, because of the projected £22bn+ NHS under-funding by 2020/21.

Social media comments from patients who’ve had treatments that are on the list of 17 give the lie to NHS England’s claim that they’re clinically ineffective.

If you’ve received any of these elective surgical procedures , please let us know  if your experience has been that they’re “clinically ineffective” or not.

NHS England expects further, faster restrictions to treatments

Now NHS England is upping the ante by its national proposal to stop funding NHSE 17 clinically ineffective interventions (unless Clinical Commissioning Groups have given prior approval).

The quango notes that Clinical Commissioning Groups have already tried to do this –

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

NHS England’s consultation document continues:

“We know that CCGs are already making efforts to reduce these interventions and we expect to see further, faster progress in 2018/19 in light of this programme…

We have increasingly encouraged CCGs and providers to work together through
STPs and ICSs to transform services locally. In line with this, we expect CCGs and providers to work collaboratively in implementing these changes and agreeing how any released capacity is deployed for the benefit of patients. They will need to work together with provider clinicians and GPs to ensure the clinical changes are put into effect. It is important in the early stages of implementing the changes that account is taken of the likely financial impact on providers, particularly where the changes in the volume of activity are likely to be significant. We would expect that the freed up capacity will be used for other elective activity, for example to improve performance against the Referral to Treatment (RTT) standards, as part of plans agreed with CCGs.”

This is about the 18 week target for patients’ referral to consultant for elective care, which the NHS in England has been unable to meet because of government underfunding.

The solution to that problem is to fund the NHS adequately – something that May’s extra £20bn will not do, because that money is earmarked to set up Accountable/Integrated Care Systems in order to increase life sciences and digitech corporate profits.

Zero payment to providers for delivering these treatments – except where commissioners have given prior approval

NHS England will enforce these cuts to the 17 elective treatments through changes to the National Tariff and NHS Standard contract in 2019/20. This will mean that providers are not paid for delivering these treatments – unless in exceptional circumstances where prior approval of an Individual Funding Request has been given by the commissioner. This will:

“enable the commissioner to withhold payment for the relevant procedure where the provider treats a patient without evidence of an Independent Funding Request approval (Category1) or other prior approval (Category 2).”

They say  Category 1 treatments are either clinically ineffective or have been superseded by newer treatments, and that Category 2 treatments have only been shown to be effective in certain circumstances, so Clinical Commissioning Groups will only approve them on the basis of  fixed clinical criteria –  which they’ve not yet agreed.

So these procedures are clearly NOT clinically ineffective, since they can still be used if the Clinical Commissioning Group gives prior approval. Why would NHS England fund/approve/provide them at all, if they were really clinical ineffective?

As we’ve already commented in relation to the South Yorkshire and Bassetlaw Integrated Care System’s similar policy this is about restricting clinicians’ ability to use their professional skills and knowledge, in relation to their patients.

Do they want to employ doctors or sheep?

Sheep will better follow algorithms that determine criteria for treatment.

As with the mandatory Integrated Urgent Care Service that NHS England has commanded all Clinical Commissioning Groups to procure by April 2019,  the quango is yanking clinicians and local NHS commissioners into line, to follow centrally dictated algorithms that determine what treatments they should provide for their patients.

Patients’ GPs will no longer be in control of the decision or justification for referral. What is this going to do to the doctor-patient relationship?

This is imposing Managed Care along the lines of the USA’s Medicare/Medicaid system, where insurers dictate to doctors what treatments they can provide to which patients, on the basis of financial considerations.

The consultation document shows that the scheme is really about standardising the provision of these elective treatments across the country. At present, there are wide differences in the level of use of these treatments by different Sustainability and Transformation Partnerships, Clinical Commissioning Groups and hospital Trusts.

Might there not be valid reasons for this?

This is only the start – the programme “could rapidly expand”

The Consultation Document says:

“One of the reasons similar initiatives have failed in the past is because they aimed too wide too soon. Through subsequent phases, the programme could… rapidly expand.”

It continues:

“We intend to make this a much wider, on-going programme, subject to making sufficient progress in the first phase. We will consult on further interventions in phase two, which will be launched in the new year. We will keep the list under periodic review as the evidence base grows in future years. Phase two will also include specialised services, which are commissioned by NHS England.”

NHS England has another think coming. #NHS4All – not Medicare/Medicaid.