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”.