The 2nd lot of so-called evidence-based interventions have now been removed from routine NHS funding.
Have you been affected by the withdrawal of routine NHS funding for the first 17 “evidence-based interventions” – either as a doctor or a patient? Please tell us by emailing: email@example.com
And ditto once the second wave of 31 “evidence-based interventions” have routine NHS funding withdrawn from 1st April 2021?
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Of course we knew these 31 diagnostic tests, treatments and medical procedures would be withdrawn from routine NHS funding. The consultation last summer was little more than a tick box exercise. But we still registered our ‘patient opposition’ to the proposal.
Our key objection was (and remains) 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.
The NHS Standard Contract already requires compliance with the withdrawal of routine NHS funding for 17 so-called Evidence-Based Interventions. Introduced in 2019/20, this led to the bizarre NHS ‘self pay’ scheme at Warrington and Halton Hospitals, which was only suspended after a public outcry.
Now for 48 treatments, doctors’ freedom to make decisions with patients has gone. Instead GPs have to defer to the decisions of bean counters, through submitting individual funding requests to the Clinical Commissioning Groups. As well as damaging the doctor-patient relationship, this increases GPs’ workload unnecessarily, when they are already struggling to cope due to years of underfunding and understaffing. Not to mention the Covid-19 pandemic.
Guidance on the 31 interventions has now been issued by the Academy of Royal Medical Colleges. And the consultation document on the 2021/2 NHS Standard contract (which NHS commissioners use to contract for all healthcare services apart from primary care) says the Contract will require compliance with the withdrawal of routine NHS funding for these 31 interventions.
In Calderdale, by January 2020 restricted access to the 17 interventions had contributed to a reduction in both operations and outpatients activity. Calderdale Clinical Commissioning Group reported a 4.1% reduction in elective “spells” to date in financial year 2019/20.
Now NHS bosses say that cutting the use of these further 31 diagnostic tests, treatments and medical procedures will help reduce the waiting lists that have resulted from hospitals being overwhelmed by Covid-19 (although they don’t use the word “overwhelmed”).
Leeds Keep our NHS Public Chair, Dr John Puntis, said,
“Once again the label “evidence based” gives the appearance of legitimacy and deflects critical challenge to an exercise designed to reduce available procedures and save money. Rather than let doctor and patient explore needs, expectations and possible interventions informed by the best available science (the essence of ‘evidence based medicine’), choice is curtailed through contracting regulations. There is every reason to expect many more treatments will be added to the list as part of NHS England’s overall rationing strategy. Patients and the public must continue to object.”
West Cumberland Hospital consultant Mahesh Dhebar said,
“These are some complicated clinical decisions.
For example, I agree normally there is no need for an MRI scan for arthritic hip, however, in some younger patients with Arthritis, where there is a need to save ball of hip joint, and to consider some newer type of surface replacement of Hip joint, MRI scan is necessary, so blanket ban of refusal for funding for MRI scan of the arthritic hip will not work.
Same way, Number 19 on the list, ‘Low back pain Imaging’.
Imaging of the back can include, simple X-ray, Bone scan, CT Scan, or an MRI scan of the spine, depending on clinical presentation.
Imaging of the spine is necessary not only to diagnose the cause of pain, and symptoms, but also to rule out, some serious secondary conditions due to trauma, or Cancer.
So to refuse to pay for imaging of low back pain, as the blanket ban, may well cost NHS more in the long run.
Somewhere along the line, there may be a medico-Legal issue.
If the treating clinician request some investigative, or surgical procedure, and management decision-makers refuse to approve then the clinician can rightly document in the patient’s note, that this procedure was advised, on the clinical ground, but could not be done, as it was not approved by management decision-makers.”
Increasing privatisation of NHS diagnostic services
It seems strange that stopping routine NHS funding for so many diagnostic tests coincides with increasing privatisation of NHS diagnostic services. For example, Somerset NHS Foundation Trust has contracted Rutherford Diagnostics to provide a Community Diagnostic Centre (CDC) in Taunton. The press release from Rutherford Diagnostics partner Philips Health UK states,
“In addition to providing services to NHS patients, the centre will be available to private medical insurance and self-pay patients in the South West.”
This is the first of five new community diagnostics centres across the UK that Rutherford Diagnostics and Philips Health UK are due to set up, under an agreement between Rutherford Health plc and Equitix, a private equity company. The Equitx website says
“Equitix is majority owned by TFG Asset Management L.P., a diversified alternative asset management business that owns majority and minority private equity stakes in asset management companies. Approximately 25% of the economic interests in the Equitix group is owned by Equitix’s management team. TFG Asset Management is part of Tetragon Financial Group Limited, a closed-ended investment company that is traded on Euronext in Amsterdam N.V. and on the Specialist Fund Segment of the main market of the London Stock Exchange.”
The Rutherford Community Diagnostics Centre in Somerset was opened in September 2021 by Professor Sir Mike Richards CBE, former National Cancer Director in the Department of Health and author of an October 2020 review of NHS diagnostics capacity, Diagnostics: Recovery and Renewal.
Sir Mike said:
“I’m delighted to have formally opened the first community diagnostics centre run by the independent sector in partnership with the NHS.”
The Health Service Journal reports that Somerset NHS Foundation Trust is paying Rutherford so the NHS hospital staff can use the facility, which Rutherford has refurbished using privately raised capital (from Equitx) and which includes equipment provided by Phillips.
The cost to Somerset NHS Foundation Trust is discounted because its staff will be delivering activity for Rutherford’s private patients as well as NHS cases. The clinicians will continue to provide emergency and some other diagnostic services at the trust’s Musgrove Park Hospital. Somerset Foundation Trust and Rutherford are running the facility as a partnership underpinned by contracts, rather than creating a formal entity such as a joint venture.
Peter Lewis, CEO of the trust told HSJ,
“No one quite knows what the financial regime will look like for providers tomorrow, so that will need to be worked through, but from our perspective this is the most cost-effective way to meet the demand.”