NHS England can stuff its plan to cut 17 vital treatments

The government and its quangos are whipping the NHS rug from beneath our feet.

As hospital beds and services are being axed across the country, NHS England is “consulting” on cuts to 17 vital elective surgical procedures. It plans to stop funding them from April 2019 – except in exceptional circumstances that require a patient’s GP to ask their Clinical Commissioning Group for prior approval or an “individual funding request.”

The NHS England spin is that the 17 procedures are ineffective. They are not.

They are effective for certain patients in certain situations. Already, they are only provided for patients whose condition meets clear clinical criteria. They should continue to be routinely funded, and clinicians and patients should be trusted to make appropriate decisions about referral and treatment.

Anything else would undermine a core NHS principle – that the full range of appropriate treatments is available to everyone who has a clinical need for them.

By driving those who can afford it to pay for private treatment, NHS England’s plan would amount to de facto NHS privatisation. It would accelerate the move to a two tier health system in England: private for those who can afford it, and a limited NHS service for those who can’t.

Their aim is to cut NHS spending by £200m/year

This is how private health insurance schemes work. Our comprehensive NHS, that provides the full range of appropriate treatments on the basis of patients’ clinical needs, does not work like this.

These 17 treatments are only the first batch of cuts to elective care – NHS England plans to rapidly expand the number of elective treatments it will outlaw.

It proposes to do this by two means.

First, by preventing commissioners from paying hospitals for providing these treatments to patients – unless exceptions have been approved. For four of the treatments, there will only be exceptions for 1-5% of patients.

Second, it is replacing the current referral and decision making process – based on informed, individual discussions between GP, patient and specialist – with a national set of algorithms in a standardised electronic referral system.

This rules out any consideration of patients’ individual circumstances, needs and values. It reduces clinicians to technicians and wastes their hard earned skills and knowledge.

This change to the referral process is already happening, through the introduction of GPs’ electronic referrals – so the consultation is predetermined. NHS England have made up their minds and started implementing this proposal before they have even consulted on it.

The 17 elective surgical treatments that NHS England plans to stop routinely funding are:

Snoring surgery (absence of obstructive sleep apnoea)
Dilation & curettage
Knee arthroscopy for patient with osteoarthritis
Injections for “nonspecific “ back pain ( without sciatica)
Breast reduction
Removal of benign skin lesions
Grommets for glue ear in children
Tonsillectomy for recurrent tonsilitis
Haemorrhoid surgery
Hysterectomy for heavy menstrual bleeding
Chalazia removal
Arthroscopic shoulder decompression for subacromial shoulder pain
Carpal tunnel release
Dupuytren’s contracture release
Ganglion excision
Trigger finger release
Varicose vein surgery

There are already clear clinical guidelines for when these procedures should be considered, and already they are only provided in the most essential cases.

But NHS England alleges that clinicians are making inappropriate referrals and specialists are making inappropriate decisions to operate. It does not provide any evidence to back this up.

The proposal to restrict or deny patients access to these treatments comes from the 2009 McKinsey report. This was commissioned by the Dept of Health in order to identify how to cut NHS spending, after the government had bailed out the bankers whose unregulated greed trashed the global financial system.

McKinsey proposed around 22% of “efficiency” cuts – £13-20bn over the next 3-5 years. Of this, £4.7-£6.6m was to come from stopping “low value added healthcare interventions and ensuring compliance with commissioners’ standards”.

Nearly all the “low value” treatments in McKinsey’s report are in NHS England’s list of 17 elective treatments that it plans to stop routinely funding. The NHS England consultation notes that individual Clinical Commissioning Groups have already cut elective treatments – but not enough. The proposals are all about money and control.

CK999 are not impressed and have told NHS England why in our response to their consultation – downloadable here

What you can do about it

You can tell NHS England this is not on.

NHS England is holding two open events for people to discuss the proposals and share feedback.

The first event will be held in Leeds on Wednesday 22 August (12.00 to 14.00), at the Leeds Town Hall, The Headrow, Leeds, LS1 3AD. Registration on the day will be open from 11.30am.

ck999 intends to attend the Leeds event – if you want to as well, you can book here.

The second is in London on Thursday 23 August (10.00 to 12.00). If you want to attend, you can email: england.EBinterventions@nhs.net.

NHS England’s consultation – absurdly called ‘Evidence Based Interventions’ – is open until September 28th.

Their Consultation Document is downloadable here. Be warned, it is a bit horrendous.

You can respond to the consultation by completing NHS England’s online survey or emailing your comments to: england.EBinterventions@nhs.net.

Here is a downloadable template, that we hope might help when you respond to the consultation. Obviously, please amend the template responses as you see fit and include  your own thoughts.

Write to your MP. Write to the local paper.  Northern local papers are listed here. Southern local papers, here.

Tell your friends, family and neighbours what is going on: that if/when we get ill, increasingly we will be unable to go to the NHS for health care – because it will no longer provide a range of so-called “elective procedures”.

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13 comments

  1. Why oh why are you still cutting sevices when you have been given £20 billion more to spend or is this just some Tory trick with money juggling. When are you going to stop being yes men/women and stop selling off the NHS piece by piece can I remind you the NHS does not helong to the Tories or to you, it belongs to the people and to my knowledge we the people want a fully funded and functioning BHS with proper not for profit support services

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  2. I am from Liverpool and a friend has forwarded your article to me. This is an outrage and maybe you could make your campaign aware to the 38 degrees website where more people are likely to respond. I am disabled myself and l am sick to death of reading about cuts to the NHS. More campaigning needs to be done by the public before the NHS, which is accessible to all, becomes a distant memory.

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  3. I’ve had multiple gromits as a child and adult progressing to t-tubes, multiple d&c’s following miscarriages, removal of benign skin lesions, tonsillectomy, Haemorrhoid surgery and carpal tunnel release. Without these I would be totally deaf, in a great deal of anal pain and bleeding totally unable to sit, nor could I do anything for myself because my hands were so useless I could not even dress myself and struggled to hold even a cup. All of these surgeries were many years ago and they worked wonders for me. I want others to get the same benefits.

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  4. I find whole ethos behind this announcement unacceptable. Responsible GPs will not recommend a patient for unnecessary procedures. So there is no need for this dictate. Too many of the listed items affect women. For instance the d & c procedure is one. Without this approx every 5 years my life would have been Hell. What are you about to add to the list in a year’s time? This must not be allowed to happen

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  5. It’s money juggling, they have put in 20 billion that they previously took so in effect they have put nothing in. The intention is to make the NHS appear to be failing when the reality is, the business managers, who know nothing about healthcare, unlike clinicians who should manage, are running the NHS into the ground and taking huge salaries (taxpayers money) in the process to privatise NHS. Let’s think PWC; KPMG; Carrilion; Capita; Interserve; Virgin.

    GPs are being persuaded to defer from sending patients to see a specialist and are being rewarded with monies that are saved by not referring, as a result patients are presenting late or at A&E with stage 3/4 cancers and other serious conditions that would have been picked up earlier.It’s shameful.

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