November 2018 - NHS postcode lottery denying thousands of diabetics blood sugar monitor

The British Medical Journal (BMJ) has found that the prescription of Freestyle Libre monitors in England, used to maintain a healthy blood glucose levels for people with type 1 diabetes, is significantly behind the other home nations. The data gathered through a Freedom of Information Request shows that some areas have invested heavily in making the devices available, but only two of 195 CCGs had prescribed to more than 20 per cent of their type 1 diabetics.

Twenty-five CCGs had issued no prescriptions at all. Diabetes campaigners claim just 2 per cent of patients in England have a GP prescription for Freestyle Libre, compared to 11 per cent in Scotland, 16 per cent in Wales and 35 per cent in Northern Ireland.

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October 2018 - Local CCG cuts access to IVF treatment

Bury CCG is cutting the number of IVF cycles it offers from 3 to just 1 for new patients, effective from 1 October 2018. This is the latest in the move towards sustained disinvestment in NHS fertility services in England.

Fertility Fairness’ 2017 audit of England’s 208 CCGs shows a marked reduction in access to NHS-funded IVF. The vast majority of England’s CCGs – 88 per cent – do not follow national guidance and do not offer 3 NHS-funded IVF cycles. Seven CCGs have decommissioned NHS IVF or suspended and provide 0 cycles ( 3.4 per cent); 62 per cent offer just 1 NHS IVF cycle; 24 per cent provide 2 NHS IVF cycles and just 12 per cent follow national guidance and offer 3 NHS-funded IVF cycles. Approaching one in ten CCGs is currently consulting on reducing or decommissioning NHS fertility treatment.

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October 2018 - 2500 York people have had surgery delayed because they're obese or smoke

Information from a Freedom of Information Request has shown that NHS Vale of York Clinical Commissioning Group introduced restrictions on operations to save money early 2017. The data shows that more than 100 people a month in the Vale region are being told they face delays of a year for routine surgery if they are obese, or six months if they smoke. Since the restrictions were introduced in 2017, nearly 1,500 obese patients, 700 smokers and 200 people who are both obese and smokers have been told their surgery will be delayed unless they shed weight or give up smoking.

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September 2018 – Access to contraception services restricted

The Advisory Group on Contraception published the results of a freedom of information request showing that half of local authorities have cut or plan to cut contraception services in 2018. Across England, specialist clinics are restricting their hours or shutting down. Significantly, there’s an emerging problem for many women in getting hold of long-acting reversible contraceptives (Larcs), such as the coil and contraceptive implants.

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August 2018 – Patients forced to pay privately for hip and eye surgery due to NHS waiting times

Data published in the Telegraph and gathered by  market analysts LaingBuisson shows that since 2013, triple as many patients – around 445,000 – have had to wait more than six months for operations on their hips or cataracts. As a result, companies offering private operations have seen at 53% rise in take up of these operations. The report suggests the growth in private operations is due to the ‘very high waits for NHS diagnosis and treatment’.

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July 2018 - Hip and knee operations rationed

The British Medical Journal (BMJ) found that, in 2017, thousands of patients were forced to jump through hoops to access hip or knee operations by NHS rationing panels, despite their GP thinking surgery is necessary. Between 2016-17 and 2017-18 there was a 45 per cent increase in the number of patients rejected after their GPs recommended them for surgery via an exceptional funding application.

Ian Eardley, senior vice president of the Royal College of Surgeons said: “The use of funding requests means patients will spend more time in pain with potential deterioration of their condition, thereby generating further costs for a system already under acute financial strain.”

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July 2018 - Hernia patients restricted access for inguinal hernia surgery

 Hernia patients are being forced to prove they are in so much pain they cannot go to work before they are given an operation, the Royal College of Surgeons found. The RCS survey found that the majority of CCGs are refusing to pay for surgery until patients are so debilitated their everyday life is affected.

Susan Hill, Senior Vice President of the Royal College of Surgeons said: “It is an absolute disgrace that some patients have to demonstrate what could be a life-threatening complication of a hernia, which is one of the most straightforward surgical conditions to treat. Allowing commissioning groups, not patients with their surgeon, to make a decision to operate is putting patients at unnecessary risk of serious complications.”

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June 2018 - Cancer patients who've had breast removed 'are being refused vital reconstructive surgery due to NHS rationing'

A report by Breast Cancer Now has found that 47 out of 208 (22.6%) Clinical Commissioning Groups in England have introduced policies to restrict NHS breast reconstruction services for non-clinical reasons. Another nine CCGs are drafting policies or have informal restrictions in place. Clinical guidelines state all women should be offered this as it is crucial to patients’ recovery and self esteem.

Baroness Delyth Morgan, chief executive at Breast Cancer Now, said: “It is totally unacceptable that any patient is being denied the reconstructive surgery they need or rushed into potentially life-changing decisions, at such a difficult time.”

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June 2018 - cataract surgery rationing in Mid Sussex

People in Horsham, Crawley and Mid Sussex are being denied the cataract surgery in defiance of guidelines from the Department of Health. The Horsham, Mid Sussex and Crawley Clinical Commissioning Groups say they do not ‘routinely fund’ cataract operations. Only people who score worst in visual tests are considered for surgery.

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May 2018 – thousands of patients cataracts surgery despite official guidelines

Following the submission of a Freedom of Information Request by the Daily Mail, it has come to light that around two-thirds of NHS trusts are defying official guidelines by denying patients cataract surgery. Of the 196 asked, 67 per cent were found to be ignoring Nice’s guidelines, saying a person’s sight “had to be below a certain level” before they are granted a referral. Instead, only the worst affected are being put forward for procedures.

The Royal National Institute of Blind People (RNIB) told the Mail it was “outraged” by the findings.

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April 2018 - Patients 'going private' for surgery growing as NHS rationing worsens

The Telegraph reported that the number of patients paying for operations privately is soaring amid rising waiting lists and deepening rationing across the NHS. They stated that “Private companies have seen a 53 per cent rise in the “self-pay” market in four years. Analysts said the market for operations such as hip surgery and cataract operations was being fuelled by “very high waits for NHS diagnosis and treatment”. In the last four years, the numbers waiting more than six months for such operations has tripled, with 445,360 such cases by the end of last year.”

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December 2017 - NHS rationing for dementia treatment

Following the publication of a NHS board meeting report, Alzheimer’s Research UK, the UK’s leading dementia research charity flagged concerns around the rationing of treatments for dementia, arthritis, hearing loss and blindness.

Alison Evans, Head of Policy at Alzheimer’s Research UK, said “Reports that dementia treatments could be limited in future are deeply concerning, both for the people with dementia benefiting from medicines today, and for the thousands whose lives could be transformed by future developments in research. If the NHS begins to cut back on dementia treatments now, future treatments could face additional hurdles in reaching people living with dementia.”

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December 2017 – women not told about treatment for fibroids

In 2016, FEmISA, carried out a Freedom of Information request to all acute NHS Trusts in England during to find out about NICE compliance, and how it was ensured that all patients received full objective information on their treatment options for fibroids. FEmISA found 67% of Trusts take no measures to ensure women are aware of their treatment options and offered choice for treating fibroids. The organisation said that any women complain to FEmISA and other fibroid patient support

groups that they are not given any choice or told of any alternative treatment options other than hysterectomy by their gynaecologist.

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November 2017 - Cataract rationing is restricting access to surgery

The Royal College of Ophthalmologists (RCOphth) undertook a survey of ophthalmic clinical leads to understand how the current situation of visual acuity thresholds and other imposed restrictions are affecting access to cataract surgery. They found, in 2017, for access to first eye surgery, approximately 34% have no restriction to access, 62% have thresholds of moderate visual acuity2 reduction (vision of 6/9 or 6/12 or worse), but 4% of those clinics surveyed have thresholds of marked acuity reduction that is 6/18 or worse.

For second eye surgery, the access requirements are often stricter and often further restrict those in need of cataract surgery. The College said it is important that patients regain as much vision as possible and are able to use both eyes together.  This means that restoring sight in both eyes is essential to good visual function and their quality of life.

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October 2017 – Free Hearing aids cut on the NHS for the first time

The first ever rationing of free hearing aids on the NHS came into force in North Staffordshire in October 2017, with the rest of Staffordshire mirroring the cuts in the following months. Despite costing the NHS only £90 per hearing aid, people who need hearing aids in North Staffordshire will no longer get them – people with mild hearing loss are no longer eligible for free hearing aids, even if they’ve had them before, while those with moderate hearing loss will be required to meet additional criteria in order to receive them.

Paul Breckell, Chief Executive of charity Action on Hearing Loss said this decision “sees people with hearing loss bearing the brunt of NHS rationing… The cuts run contrary to the robust independent evidence which shows the importance of hearing aids, and the views of local people who tell us that hearing aids can be life-changing.”

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September 2017 - CCGs arbitrarily restricting access to hernia surgery

An audit of published CCG guidance undertaken in December 2016 found a significant number of CCGs class inguinal hernia repair as a procedure of limited clinical value (PLCV) and are restricting patient access. The Hernia Outcomes Campaign audit found:

  • Over a third (31%) of all Clinical Commissioning Groups are reducing access to hernia surgery
  • Over half (54%) of CCGs with publically available guidance have reduced access to inguinal hernia repair.
  • Patient access restriction has led to unacceptable regional variation and sets worrying precedent for NHS England rationing procedures without appropriate assessment of clinical outcomes.

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July 2017 - Arrhythmia patients denied access to life-saving treatment

Arrhythmia Alliance has raised concern for high risk arrhythmia (heart rhythm disorder) patients who are being ‘secretly’ denied access to life-saving treatment due to an ‘indefinite’ NHS England ‘evaluation process’. The Alliance published on their website that “We are receiving calls now on a weekly basis about people concerned about the threat of a debilitating or life-threatening AF-related stroke, for example, a couple from Surrey, husband John has had 3 AF-related strokes and 2 TIAs, yet due to lack of funding cannot access this potentially life-saving treatment (Left Atrial Appendage Occlusion – recommended by NICE guidance), and would have to pay for it privately.”

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June 2017 - NHS commissioning groups restrict weight loss surgery

A Freedom of Information Request submitted to all NHS CCGs has found that several CCGs have adopted policies which attempt to ration weight loss surgery to the super-obese, and ignore official advice on who should be eligible for surgery.

The joint request made by the British Obesity and Metabolic Surgery Society (BOMSS) and the Royal College of Surgeons (RCS) found some CCGs either require patients to stop smoking or for patients to have a Body Mass Index (BMI) of over 50, despite NHS England and the National Institute for Health and Care Excellence (NICE) stating that surgery is cost effective and should be considered for patients with a BMI of over 35 with a co-morbidity (a further medical condition) such as Type II diabetes, or a BMI of 40 without a co-morbidity.

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April 2017 - Access to test strips for Diabetics becomes a postcode lottery

Diabetes UK is concerned that people with diabetes are experiencing restrictions in their access to test strips and meters. They have conducted three surveys since 2013 to monitor the restrictions and assess the impact on people with diabetes. The most recent survey conducted from March to May 2016 found that 27 per cent of the 1,000 respondents have, in the past 12 months, been refused a prescription for blood glucose test strips or have had the number of test strips on their prescription restricted. Of these, over half (52 per cent) have Type 1 diabetes.

This is of particular concern as NICE recommends that all adults with Type 1 diabetes should routinely self-monitor their blood glucose levels, and test themselves at least four times a day, including before each meal and before bed. For people who are frequent drivers, taking regular exercise or who are at high risk of hypos this could increase to around ten times a day.

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March 2017 - Hip and knee replacements rationed by hidden barriers

The UK Orthopaedics Industry Group launched a report in March 2017 which found that CCGs are using factors such as Body Mass Index (BMI) to set arbitrary thresholds for receiving treatment. This practice is not supported by any clinical evidence and has been repeatedly criticised by the Royal College of Surgeons.

Key findings from the report are:

  • 98 CCGs out of 209 have some form of arbitrary threshold in place
  • 8 have a BMI threshold of 25 – BMI 25 is considered ‘overweight’
  • 20 have a BMI threshold of 30 – the lowest BMI classed as ‘obese’
  • Of the 141 CCGs with an available commissioning policy, 69% have a BMI threshold
  • 47% of all CCGs have a BMI threshold in place

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