West Yorkshire and Harrogate clinical commissioners decide on restricting patients’ access to 17 elective surgical procedures.

West Yorkshire and Harrogate Integrated Care System clinical commissioners are being asked to restrict patients’ access to 17 elective surgical procedures, in line with NHS England’s guidance. At their meeting on 8th January, the Joint Clinical Commissioning Committee is to consider a report that summarises NHS England’s guidance and recommends accepting it.

Update 

The meeting of course accepted the report and NHS England’s guidance, which is their response to the Consultation last year.

Both NHS England and the Joint Clinical Commissioning Committee report claim that many patients have been operated on, who will not benefit from these surgical procedures. And that this is the reason for restricting patients’ access to them.NHS England’s guidance tells Clinical Commissioning Groups to only pay for four of these operations if they have approved Individual Funding Requests, and for the others, to require doctors to show that the patient meets the specified clinical criteria
through a prior approval system. Who knows how this prior approval system will work?

NHS England’s guidance was published at the end of November, following the quango’s poorly-publicised public consultation on the proposed cuts to the 17 elective procedures.

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CK999 has some questions for the Clinical Commissioning Groups

What is the evidence, if any, that these procedures have been offered to West Yorkshire and Harrogate patients who will not benefit from them?

The report identifies £9.38m “potential financial benefits” from imposing Individual Funding Requests and Prior Approval to referrals to the 17 elective procedures (although this doesn’t take account of the costs of providing alternative treatments and that in the majority of cases these costs will partially or wholly offset the cost savings from not carrying out the procedures). What clinical innovations, and innovations in prescribing and technology to improve individuals’ ability to self-care, is the Joint Clinical Commissioning Committee proposing to spend the net savings on? (If there are any, once the costs of providing alternative treatments are factored in.)

The report says the Commissioners don’t know where in the “system” the “savings” from cutting the procedures will accrue, because that depends on local contracting arrangements, such as: the presence of aligned incentives contracts, the degree to which these interventions are included in the aligned incentives contract, and the proportion of the activity that takes place in the private sector.

  • How many of the West Yorkshire and Harrogate Clinical Commissioning Groups have aligned incentives contracts with their District General Hospitals?
  • How many have included these procedures in the Aligned Incentives Contract?
  • How will Aligned Incentives Contracts distribute any savings, from restricting patients’ access to these procedures, between commissioners and hospitals?
  • If the savings accrue to hospitals not commissioners, how will commissioners make sure that hospitals spend the savings on innovative clinical interventions and prescribing and technology for patients’ self care?

Which elective surgical procedures in which Clinical Commissioning Groups’ areas are currently subject to tighter local clinical criteria than in NHS England’s statutory guidance? Are they now going to loosen the local criteria? And which of the procedures in which Clinical Commissioning Groups’ areas are currently subject to looser local clinical criteria than in NHS England’s statutory guidence?

The report says that NHS England’s statutory guidance can be regarded as mandatory and that this means that no local engagement is needed. Saying that this guidance “can” be regarded as mandatory implies that it can also be regarded as not mandatory. In the NHS England consultation, patients and public consistently rejected the proposals, with only a small minority agreeing with the proposed restrictions. So why does the update recommend acting on NHS England ’s guidance – which it seems may or may not be mandatory – without asking West Yorkshire and Harrogate patients and the public if we agree with it?

 

 

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