If you ever doubted that our NHS was being destroyed we can now see clear evidence of this as our CCGs start to debate and vote on increasing thresholds for NHS treatments. We have also seen examples of proposals to ration services by cutting the numbers eligible for NHS treatment by excluding people who for example are obese or smokers. I have already mentioned in this blog about how individuals from outside the EU are expected to pay upfront for NHS care if they become sick. That is another example of healthcare rationing. East Sussex Healthcare Trust already has an annual deficit of around £49m. Our Government has charged STP boards with making changes to absorb deficits. Cuts are inevitable and it is hard to believe that the changes I am going to mention in this post will achieve the elimination of that deficit. This is just the start of things to come …
Clinically Effective Commissioning (CEC) is a term adopted by the Sussex and East Surrey STP Board when they identified a list of procedures that they deem to not be a priority for funding. They have come up with an update on policy that they hope CCGs across the region will all adopt.
The treatments they have identified as not being a “sensible use of finite NHS resources” are divided into three tranches. We need to pay attention to the words ‘finite resources’. This is what STP is all about – making sure that in each region a specified amount of money is spent on healthcare. That is what accountable care means – giving each region a finite sum of money and if need requires more to be spent then that need goes unmet.
Nobody is saying that we have an unlimited amount of money that can be spent on our NHS. But, if we could revert back to having a NHS that is publicly funded and provided we would have the most effcient means of delivering healthcare to the nation and we could afford to offer healthcare that would serve the needs of everyone.
The first tranche of treatments have already been identified by CCGs and signed-off by their governing bodies. The aim in the CEC is to update and standadise policy so all the CCGs in the area adopt the same changes to thresholds (the level of need at which treatment is offered).
Tranche 1 treatments are:-
- Reduction mammoplasty
- Augmentation/ Mammoplasty
- Rhinoplasty/ Septorinoplasty
- Asymptomatic gallstones
- Circumcision
- (Adeno)Tonsillectomy
- Blepharoplasty
- Chalazion
- Female sterilisation
- Trigger finger
- Hallux valgus/ surgical treatment of bunions
The second tranche of treatments identified are those being considered and signed-off by CCGs. These consist of procedures for which there is considerable variation in existing policies between CCGs or no policy
Tranche 2 treatments are:-
- Treatment of minor skin lesions
- Excision of Haemorrhoid
- Hernia treatments
- Varicose veins
- Surgical treatment of Carpal Tunnel Syndrome
- Excision of Ganglia
- Dupuyutrens Contracture
- Arthroscopy/ Knee washout (in patients with knee osteoarthritis)
- Penile implants
- Vasectomy
- Grommets in older children and adults (ventilation tubes) (insertion of)
- Grommets in children under 12 (ventilation tubes) (insertion of)
- Bone anchored hearing aid -unilateral
- Correction of brow Ptosis
- Female Genital Prolapse/ stress incontinence (assessment of)
- Hysterectomy for heavy menstrual bleeding
- Uterine fibroids (minimally invasive surgery for)
- Discectomy for lumbar disc prolapse (elective)
- Epidural injections for lumbar back pain
- Therapeutic facet joint injections/ medial branch blocks
- Acupuncture for Non-Specific Low Back Pain
- Obstructive Sleep Apnoea in adults
Tranch 3 treatments are those where work has yet to be completed regarding review of the evidence and engagement in relation to proposed changes to policy.
Tranche 3 treatments are:-
- Fertility preservation techniques
- IVF
- Cataract Surgery
- Hip replacement surgery (primary)
- Knee replacement surgery (primary)
- Bariatric surgery
It has always been an admirable quality of the NHS that treatment is offered without judgement of a patients life or character. Smoking is far more prevalent in communities which are suffering deprivation and very prevalent amongst those with mental health problems. It is a reaction to suffering stress – should we really condemn people because they are stressed? Obesity too is most prevalent in lower income communities. If you look at the cheaper foods available in our supermarkets they are often packed with sugar, salt and fat. If we deprive the obese of NHS care we are passing an unfair judgement and once again condemning a person for something they may be powerless to change. We all at times will do something that is bad for our health and should be encouraged and assisted to make healthier lifestyle choices. But to pass judgement by denying a person healthcare is unlikely to be helpful. If a person becomes seriously ill because they were not entitled to healthcare then they may have to stop work, need more support, their families and friends may be effected and we will be making a rod for our own backs.
I don’t want to live in a country where anyone is left to suffer or die because of where they come from. Racism has already gone too far. Our NHS has only ever survived because of the input of workers from other countries. How then can we start denying somebody healthcare because they come from outside the EU and can’t afford to pay upfront?
I have been proud of living in a multicultural society with laws against discrimination. Britain has always felt like a nation where everybody is considered equal. I have been dismayed to hear some talk about how foreigners are stopping Britain being British. I don’t believe that it is true, I see these policies in healthcare as stopping Britain being British.
The CEC is the first steps we have seen identified in how the STP board will address the defcitits of our hospital trusts. If the STP board were to publish all its proposals for how our hospital services are to change then it is likely we would see a public outcry that could not be ignored, as has happened in many other areas.
The big fear is that in order to avoid that public outcry changes will be made by our STP board using a drip-drip approach in the hope that by the time the public wakes up to what is happening it will be too late to reverse the proposals. We really need to get on with growing this campaign and making sure a public outcry happens as soon as possible.
Don’t forget this campaign has a Facebook page and a group and you can also sign up to the mailing list by clicking on the button in the right hand column of the home page in this website. Follow this link to see the pdf document from which I found the information about CEC.
