Please say ‘no’ right now to withdrawal of routine NHS funding to 31 tests, treatments and medical procedures!

After ending routine NHS funding for 17 ‘planned’ operations in 2019, NHS England/Improvement now intend to extend this withdrawal of funding to 31 diagnostic tests, treatments and medical procedures.

Consultation on Wave 2 of the so-called Evidence Based Interventions Policy ends on Monday August 24th.

(Update 29.8.2020) This is the Patients’ Association response (downloadable, below). They are not impressed.

Sorry for short notice, but please will you respond to the consultation now?

If you are not in favour of further financial restrictions to GPs’ ability to decide with us – their patients – what is the most appropriate treatment for a wide variety of ailments, you are welcome to copy/ amend the email below and send it to EBI@aomrc.org.uk with the subject heading “Evidence Based Interventions-Wave Two consultation”.

This is NOT evidence-based medicine

The “engagement” document justifies stopping routine funding for these procedures on the grounds that this will avoid unnecessary harm to patients and waste of resources.

Of course doctors are already very aware of these issues – they are not new (“I will do no harm or injustice” – Hippocrates, 500 BC).

Our key objection is that – whatever the merits or demerits of the clinical judgements that the 31 procedures are over-used – real evidence-based medicine means trusting our doctors, not micro-managing them. Let them do what they feel best in consultation with the particular patient.

This is the basis for our registering ‘patient opposition’ to the whole process.

Also, having to make special cases for funding to the Clinical Commissioning Groups increases GPs’ workload unnecessarily, when they are already struggling to cope.

An average 40% cut to 13 procedures where there’s enough data to set a target

These new commissioning restrictions aim to cut at least 350,000 “spells of activity” for 13 treatments which have sufficiently robust data to set a “reduction opportunity”. This amounts to an average cut of about 40% for these treatments, which include some blood testing for heart attacks patients, along with endoscopies as a first-line for investigation of suspected gastrointestinal disease.

There is not enough data about the other 18 procedures to set a target for restricting access to them. They include colonoscopies, appendectomies, and imaging for shoulder pain.

Instead of these 31 procedures, the engagement document proposes alternatives to be carried out in primary care.

An Advanced Nurse Practitioner commented,

“ Chest xray, Endoscopy, Colonoscopy Wow! And they say with a straight face they hope to detect cancer early. Nuts”

Effects of Covid-19 on hospitals – the context for these cuts to elective procedures

The Expert Advisory Committee, roped in to run the consultation, says that the effects of Covid-19 on NHS hospitals has intensified the need for these the proposed cuts.

Long waiting lists have built up while hospitals were more or less closed for elective care during the onset of the pandemic. In order to give these patients the treatment they need without too much delay, at the end of July, NHS England instructed hospitals to resume near-pre Covid levels of elective activity by October.

But West Yorkshire and Harrogate Integrated Care System’s Director of Improving Planned Care has told us it will not be possible to resume pre-Covid 19 levels of planned care, because of:

“[A]dditional infection prevention and control procedures that are required to maintain safety during elective procedures during the coronavirus pandemic…We also have to plan for the likelihood of local outbreaks of coronavirus and future periods with high numbers of people requiring hospital admission and intensive care.”

Email: Evidence Based Interventions-Wave Two consultation

Please copy or amend this email as you see fit and send it by Monday 24th August to: EBI@aomrc.org.uk

Dear AoMRC,
I have looked at the background to the ‘EBI Wave Two 31 interventions’. As a patient, I am getting in touch to register my objection to this process.
I understand that my doctor has been trained in evidence-based medicine, has my interests at heart, and is best placed to be aware of risks and benefits as well as costs of any particular treatment.

My key objection is that – whatever the merits or demerits of the clinical judgements that the 31 procedures are over-used – real evidence-based medicine means trusting our doctors, not micro-managing them. Let them do what they feel best in consultation with the particular patient.

This is the basis for my registering ‘patient opposition’ to the whole process.

Also, having to make special cases for funding to the Clinical Commissioning Groups increases GPs’ workload unnecessarily, when they are already struggling to cope.

I also understand that many specialist societies within medicine and surgery and the National Institute for Health and Care Excellence produce detailed evidence-based guidelines on interventions. I cannot see the additional value of an Expert Advisory Committee producing recommendations that will result in commissioners restricting some treatments for patients according to imposition of strict criteria.

This seems to run counter to the basic principle of Evidence Based Medicine –“the integration of individual clinical expertise with the best available research evidence from systematic research and the patient’s values and expectations.” Strict treatment access criteria imposed through commissioning undermines the doctor-patient relationship and the importance of the patient’s values and expectations being taken into account.

Please note my objection to the whole exercise, which I feel can only be seen as financially-driven – the result a decade of serious under-funding of the NHS.

Please put doctor and patient back in control, and remember “nothing about me without me”.

30 comments

  1. This madness needs to stop NOW defending the NHS to allow privatisation is not only contrary to the ethics of the profession its criminal

    Like

  2. Please stop privatising more and more bits of our NHS. The most wonderful tribute from a Government is to take care of the health of all its citizens from birth to death, without them having to worry about costs in crises.

    Like

  3. Treating illness and promoting good health are the principals that the NHS was founded on 72 years ago.
    Don’t undermine that by restricting patients access to tests or treatments by preventing GPS using there clinical judgement, that’s their job, not appealing arbitrary rules.
    Conditions don’t disappear because financial policy now says NO.

    Like

  4. Done and sent with my thoughts added.
    Proactive rather than reactive should be the way to go.
    Saving what may appear to be pounds on unnecessary funding on certain investigations to spend thousands down the line is lunacy but then what do we expect with the private sector knocking on the door!

    Like

  5. We must put patients before profits and let the clinicians not the politicians decide on our best treatment plan.
    We are all individuals and do not fit into one box. Patient care should always be from an holistic approach using evidence based practice this may incorporate utilising proven diagnostic tools to support decisions.
    Please don’t allow any more of our NHS to be sold down the river at our health’s expense.

    Like

  6. It’s not called the Private Health Service, nor the Cherry-Picked Health Service, nor even the State Provided Fallback Health Service for Those Who Have Failed to Secure Private Health Insurance.

    It’s called the National Health Service.

    It was intended to be provided by the Nation, to the Nation for the benefit of the Nation.

    Let’s restore it to that and keep it that way.

    Email from the article above copied and sent to:

    EBI@aomrc.org.uk

    with the subject heading: “Evidence Based Interventions-Wave Two consultation”

    Like

  7. STOP running this wonderful NHS into the ground. Diagnostic procedures vital for the holistic care of our patients. The doctors and nurses and wider practitioners deserve to be supported not hindered by cuts as proposed here absolutely no foresight of the potential implications for both patient and staff administering care and treatment. Ludicrous!!!!!

    Like

  8. Why keep hacking away at our nhs till its bare and broken we have enough with things going on in 2020.
    Solidarity and support is whats needed right now.

    Like

  9. The ending of funding for these routine diagnostics and interventions is to further the privatisation of the NHS. It will force patients to endure the pain and distress of their condition or to pay for private care. If any intervention is deemed of low clinical value then it should not be carried out whether a patient can pay for it or not. If these changes are implemented it could lead to over treatments in private hospitals as the sole aim of private companies is to make a profit. Furthermore many of the scanners used in diagnostics are owned by private companies who receive payments whenever they are used. The NHS was founded on the principle of universal, comprehensive care based on need and not the ability to pay. It should stay this way.

    Like

  10. The NHS IS NOT THE GOVENMENT,S
    It has been slowly eaten into with private companies.
    Tenders higher and little experience of the NHS.
    Over NHS with lower tenders and the experience to do the job. Making it look like it’s the NHS at fault.
    Sorry this is eroding into our NHS. And waste of hard earn public money. NIS and tax.
    Give back the full running of the NHS to NHS And take the NHS out of politics.

    Like

  11. We need to preserve our NHS. It needs to be fully funded. It’s the best please don’t ruin it by selling it off to private companies

    Like

  12. We need a fully funded NHS that is free at the point of need . One that has no private profiteering service providers extracting Wealth from our NHS

    Like

  13. This is just awful. If we don’t have the ability to pay when further investigation is needed, patients will suffer needlessly. I have arthritis in both knees and been told I need knee replacement surgery but there is a 2year waiting list. A junior doctor refused me 10% Ibuprofen gel. It’s on a list of items not to be prescribed. But it’s not available without prescription. I worked all my adult life and paid my taxes and NI. Our NHS is being destroyed and preventing GP’s from giving patients the help they need.

    Like

  14. We must put patients before profits and let the clinicians not the politicians decide on our best treatment plan.
    We are all individuals and do not fit into one box. Patient care should always be from an holistic approach using evidence based practice this may incorporate utilising proven diagnostic tools to support decisions.
    Please don’t allow any more of our NHS to be sold down the river at our health’s expense.

    Like

  15. This is encroachment on public right and welfare system bit by inexorable bit. We need to stand together and firmly say no to any such attempts by the government. COVID has shown the dire consequences of an underfunded beleaguered NHS. It is poor economy to cut services to the NHS.

    Like

  16. I’m sure this will lead to a large population of people not being able to afford going to a doctor and as a result there will be a lot of unnecessary and premature deaths. There will definitely be sad and catastrophic repercussions.

    Like

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