2017 Ration Watch Campaign

Procedures of clinical value being limited by CCGs

CCGs are creating lists of treatments that they either don’t offer to patients or place thresholds on patient access. Increasingly these lists include treatments that are proven to be effective and beneficial to patients.

Overview

Hernia: 95 CCGs, almost half, currently have hernia repair listed in their Procedures of Limited Clinical Value (PoLCV) or threshold list. CCGs are increasingly taking a ‘watchful waiting’ approach to hernia management which could mean an increase in emergency cases and worse patient outcomes.

Cataracts: 104 CCGs, that’s over 50%, include cataract removal on their list of PoLCV and over a third, 76 CCGs, include a visual acuity threshold. Cataract removal is the most common procedure performed on the NHS and is proven to be effective. Both NICE and the Royal College of Ophthalmology state that treatment decisions should not be based on visual acuity.

Continuous Glucose Monitoring: 12 CCGs do not commission Continuous Glucose Monitors (CGM) and a further 7 CCGs only commission via independent funding request. CGM is recommended by NICE as part of diabetes management and is proven to help people manage their diabetes.

Hip and knee Replacement: 78 CCGs include hip and knee replacement on their PoLCV lists. Hip and knee replacements are proven to be effective and have been supporting people to keep mobile for over half a century.

PoLCV

‘Procedures of Limited Clinical Value’ traditionally referred to treatments that do not have sufficient data to prove their cost effectiveness or clinical benefit. It was originally applied to treatments such as alternative and complementary therapies and cosmetic procedures. Procedures included on these lists were generally not funded by NHS commissioners.[1]

However, commissioners are increasing using PoLCV as a way to control spending by limiting access to treatments and technologies that are proven to be effective. Ration Watch conducted analysis of all 195 CCGs to look at the types of procedures they include on PoLCV lists.

Ration Watch found a number of proven treatments included on PoLCV lists. Four of the treatments listed most frequently were – hernia repair, cataract removal, Constant Glucose Monitoring and hip and knee replacements. Most commonly with these procedures, CCGs are using access thresholds to limit patient access.

What we found:

Hernia

A hernia occurs when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall, several surgical techniques exist to fix hernia. Hernia repair is one of the most common procedures performed in the UK, with around 80,000 taking place each year.[2] There is guidance on hernia repair from NICE[3] and the Royal College of Surgeons[4]. The National Institute for Health and Care Excellence (NICE) guidance states that surgical repair should be undertaken in most individuals with an inguinal hernia in order to close the defect, alleviate symptoms of discomfort and/or prevent serious complications, such as obstruction or strangulation of the hernia.[5] The Royal College of Surgeon’s guidance is clear on the impact of delaying treatment, ‘CCGs should not set criteria for referral and treatment for inguinal hernias outside that recommended in this guidance, as this approach produces worse clinical outcomes and has not been shown to be cost effective’. There is a strong evidence base and proven record of successful outcomes following hernia repair operations.

Despite this, ration watch found that 95 CCGs, almost 50%, include hernia repair on their PoLCV lists or lists of Threshold Policies.  The type of policies related to hernia repair commissioning are often described as a ‘watchful waiting’ approach. Whilst this type of approach may be appropriate for some patients, using this approach more widely could mean more and more patients will only receive treatment when their condition deteriorates and they require an emergency intervention.

Cataract Removal

Cataract surgery involves replacing the cloudy lens inside your eye with an artificial one. It’s the most common operation performed in the UK, with a high success rate in improving your eyesight.[6] The Royal College of Ophthalmology has clear guidance for commissioners on the commissioning of cataracts.[7] There is also a NICE guideline in relation to cataract management.[8] The Royal College of Ophthalmology are clear on the need to treat patients early stating that the ‘presence of cataract causes disability and increases the likelihood that individuals will suffer adverse events such as falls’ and that ‘…Cataract surgery is the only effective intervention to treat cataracts and is cost effective.’[9] Both NICE and Royal College of Ophthalmology say that access to cataract removal should not be restricted on the basis of visual acuity.

Despite this guidance and associated evidence, Ration Watch found that 104, more than 50% of CCGs include cataract removal on the PoLCV or threshold lists. Alongside this, 76 CCGs include a visual acuity threshold in their commissioning policy.

Continuous Glucose Monitoring

A Continuous Glucose Monitor is a small device that you wear just under your skin. It measures your glucose (sugar) levels continuously throughout the day and night, letting you see trends in your levels and alerting you to highs and lows.[10] It helps people manage their diabetes by allowing them to constantly track their sugar levels, identify high and low trends and even sound an alarm at high and low levels. NICE guidelines in relation to the management of diabetes in adults include guidance on how to commission CGM. NICE guidance sets out clear criteria for the commissioning of CGM and the type of user that should be considered.

Despite clear guidance on the use of CGM, Ration Watch found 12 CCGs who do not commission CGM and a further 7 who will only do so via an independent funding request. That is around 10% of CCGs placing some form of barrier to CGM.

Hip and Knee Replacement

Total hip replacement and total knee replacement are proven orthopaedic interventions that have been supporting people for many years. In total around 200,000 hip and knee replacements take place each year in England.[11] There is clear evidence supporting hip and knee replacement. The National Joint Registry has highlighted the results of a patient satisfaction assessment which shows that 92% of patients describe themselves as feeling either ‘excellent’, ‘very good’ or ‘good’ six months after treatment.[12] The British Hip Society has guidelines for the commissioning of total hip replacement, which sets out the benefits – ‘Total Hip Replacement (THR) is cost effective, returning 90% of patients to their previous job, and enabling the elderly to keep independent. The National Tariff for THR is cheaper than long-term conservative treatment for osteoarthritis of the hip’.[13]

The Royal College of Surgeons have spoken out against the use of blanket bans on access to treatment, stating that ‘blanket bans do not best serve patient care.’[14] Despite this guidance and the evidence supporting access to treatment, Ration Watch found 78 CCGs currently include hip and knee replacement surgery on their PoLCV or threshold lists. Often the policy includes a BMI threshold, something not supported by the Royal College of Surgeons.

Conclusion

The inclusion of evidence based treatments on PoLCV and threshold lists will result in huge variation in the treatments patients receive. NHS England recently launched their ‘Evidence Based Interventions programme’. This set out 17 treatments where research evidence has shown that the treatments in question are not clinically effective or are only effective when they are performed in specific circumstances. This process is clinically led and based on the available evidence. NHS England’s work to assess treatments of limited value will be undermined by individual CCGs including treatments that are supported by decades of use and an effective evidence base.

What Ration Watch would like to see

Any decision on patient treatment should be based on clinical need. Ration Watch are calling on NHS England to set clear guidelines on which procedures can be included in PoLCV and threshold lists and which procedures should not be included. Where individual CCGs are seen to have an unfair policy, NHS England should intervene.

 

 

[1] Royal College of Surgeons, Procedures of Limited Clinical Value briefing, https://www.rcseng.ac.uk/-/media/files/rcs/library-and-publications/non-journal-publications/rcs-briefing–procedures-of-a-limited-clinical-value–jan-11.pdf

[2] Hernia Outcomes Campaign, http://www.herniaoutcomes.org/the-latest-report/

[3] NHS England, Abdominal Wall Hernia Management and Repair in Adults – https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2013/11/N-SC001.pdf

[4] Royal College of Surgeons, Groin Hernia Commissioning guide – https://www.rcseng.ac.uk/-/media/files/rcs/standards-and-research/commissioning/groin-hernia-commissioning-guide_published-2016.pdf

[5] Laparoscopic surgery for inguinal hernia repair

https://www.nice.org.uk/guidance/ta83/resources/laparoscopic-surgery-for-inguinal-hernia-repair-pdf-2294817305029

[6] NHS, Cataracts – https://www.nhs.uk/conditions/cataract-surgery/

[7] RC Ophthalmology, commissioning of Cataracts https://www.rcophth.ac.uk/wp-content/uploads/2018/02/Cataract-Commissioning-Guide-January-2018.pdf

[8] NICE Guideline NG77 – https://www.nice.org.uk/guidance/ng77/chapter/Recommendations#referral-for-cataract-surgery

[9] RC Ophthalmology, commissioning of Cataracts https://www.rcophth.ac.uk/wp-content/uploads/2018/02/Cataract-Commissioning-Guide-January-2018.pdf

[10] Diabetes UK, CGM – https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/testing/continuous-glucose-monitoring-cgm

[11] NJR, Annual Report – http://www.njrreports.org.uk/Portals/0/PDFdownloads/NJR%2015th%20Annual%20Report%202018.pdf

[12] NJR Annual Report – http://www.njrcentre.org.uk/njrcentre/Portals/0/Documents/England/Reports/10th_annual_report/NJR%2010th%20Annual%20Report%202013%20B.pdf

[13] British Hip Society, Commissioning guidance – https://www.boa.ac.uk/wp-content/uploads/2014/08/Pain-arising-from-the-hip-in-adults_updated_Final.pdf

[14]  Royal College of Surgeons, Smokers and overweight patients: Soft targets for NHS savings? https://www.rcseng.ac.uk/-/media/files/rcs/about-rcs/government-relations-consultation/rcs-briefing-paper-on-rationing.pdf

“In February this year, the CCG in West Kent implemented a policy to suspend all elective surgery until the end of the financial year in an attempt to save £3.2 million. More recently, Cambridgeshire and Peterborough CCG proposed a new policy requiring patients to wait a minimum of 12 weeks for surgery . While that decision was later reversed, it is a worrying example of the kind of policy we may see spreading across the country as the financial situation of the NHS continues to deteriorate. It is not just in surgery where such rationing applies: earlier this year, I responded to a debate in Westminster Hall on infertility treatment, and it was revealed that of 209 CCGs in England, just four follow in full the National Institute for Health and Care Excellence ‘s guidelines on IVF treatment.

The individual funding request process, once reserved for rare conditions, is routinely applied by CCGs for a range of treatments. In some areas, including east Berkshire, routine hip and knee replacements are now being considered only if an individual funding request is made. Analysis by The BMJ found that the number of individual funding requests has increased by 47% in the past four years.”

Justin Madders MP

Speaking in Westminster Hall Debate

Rationing Resources

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.

Read more here: https://www.independent.co.uk/news/health/diabetes-type-1-blood-sugar-theresa-may-glucose-monitor-health-nhs-postcode-lottery-a8622811.html

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.

Read more here: http://fertilitynetworkuk.org/bury-cuts-nhs-ivf/

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.

Read more here: https://www.yorkpress.co.uk/news/17003906.2500-york-people-have-had-surgery-delayed-because-theyre-obese-or-smoke/

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.

Read more here: https://www.theguardian.com/commentisfree/2018/sep/14/contraception-services-cuts-councils-clinics

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’.

Read more here: https://www.dailymail.co.uk/news/article-6052687/Desperate-patients-resort-paying-privately-hip-eye-surgery-NHS-waiting-times-spiral.html

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.”

Read more here: https://www.independent.co.uk/news/health/nhs-rations-operations-hip-patients-beg-treatment-cuts-funding-a8453531.html

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.”

Read more here: https://www.telegraph.co.uk/news/2018/07/16/hernia-patients-forced-prove-debilitating-pain-granted-operations/

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.”

Read more here: https://www.mirror.co.uk/news/uk-news/cancer-patients-whove-breast-removed-12732254

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.

Read more here: https://www.wscountytimes.co.uk/news/health-chiefs-defend-cataract-surgery-rationing-1-8533725

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.

Read more here: https://www.thesun.co.uk/news/6393193/cataracts-patients-denied-surgery-nhs-trusts/

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.”

Read more here: https://www.telegraph.co.uk/news/2018/08/11/numbers-going-private-surgery-soaring-nhs-rationing-deepens/

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.”

Read more here: https://www.alzheimersresearchuk.org/nhs-rationing-reports-red-flag-dementia-treatment/

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.

Read more here: http://www.femisa.org.uk/images/femisa%20report%20on%20patient%20choice%20and%20nice%20compliance%209.17%20-%20final.pdf

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.

Read more here: https://www.rcophth.ac.uk/2017/11/cataract-rationing-survey-reveals-66-of-responding-eye-units-have-some-restrictions-to-access-surgery/

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.”

Read more here: https://www.actiononhearingloss.org.uk/about-us/media/latest-press-releases/free-hearing-aids-cut-on-the-nhs-for-the-first-time/

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.

Read more here: http://www.herniaoutcomes.org/the-latest-report/

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.”

Read more here: http://www.heartrhythmalliance.org/afa/uk/news/high-risk-patients-denied-access-to-life-saving-treatment

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.

Read more here: https://oen.org.uk/2017/06/05/nhs-commissioning-groups-restricting-weight-loss-surgery-surgeons-warn-at-a-cost-to-patients-and-the-public-healthcare-bill/

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.

Read more here: https://www.diabetes.org.uk/professionals/position-statements-reports/diagnosis-ongoing-management-monitoring/access-to-test-strips-a-postcode-lottery

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

Read more here: https://www.abhi.org.uk/media/1379/hip-and-knee-replacement-the-hidden-barriers.pdf

Case Studies

FreeStyle Libre rationed for School Girl

Rosey Edwards was a baby when she was diagnosed with type 1 diabetes. To ensure test her blood sugar levels, she has had to use finger prick tests. However, she tried the FreeStyle Libre testing system, which avoids the need for finger prick tests. However, because she lives in Dorset, which does not provide the device to children on the NHS, her parents Kirsty, cannot afford the £96 a month to pay for it. Rosey wrote to Theresa May appealing for her support.

https://www.dailymail.co.uk/health/article-6366689/NHS-refusing-thousands-people-diabetes-life-changing-gadget.html

Journalist Ross Clark denied access to hernia operation

In a Daily Mail article, Ross Clark explains how, after suffering with symptoms of a hernia, he attended a GP appointment where he was told that his hernia was not bad enough to quality for funding for surgery. Because he was not in pain and did not have to do heavy lifting for his job, he was told he would not be referred to a specialist. He was told if he wanted inguinal hernia surgery, he would need to access this privately.

“It is pretty galling, after having paid all that tax, to find the NHS turning its back on me and refusing to offer an operation which used to be routine. The NHS tries to justify its penny-pinching on hernia surgery by claiming a ‘watch and wait’ strategy is better where a hernia is causing no symptoms other than a painless bulge. But that misses the point, that the type I have — which accounts for 75 per cent of all hernias — might be little bother when it appears, but will tend to grow with time until it becomes painful and uncomfortable, and possibly even dangerous.” he said.

https://www.dailymail.co.uk/debate/article-5944631/Sex-addicts-free-treatment-NHS-taxpaying-Britons-denied-hernia-operations.html

Mum waiting for NHS cataracts operation was run over 'because she can't see'

Karen Smart, a mum from Stroke, was left with barely any sight after waiting two years for a cataracts operation. As a result, she stepped out in front of a vehicle outside Derriford Hospital, suffering a fractured foot. Her family have claimed the incident would not have happened if she had been able to see the vehicle.

https://www.plymouthherald.co.uk/news/plymouth-news/mum-waiting-nhs-cataracts-operation-1558882

 

 

“North Kirklees and Greater Huddersfield, have recently released plans to introduce what they refer to as a health optimisation programme, which would restrict access to elective surgery for those who smoke or who are obese. Make no mistake, whatever title is given to the scheme, it is nothing more than a thinly hidden attempt at rationing healthcare for those in need. Smokers would be given six months to quit, and for those who are considered to be obese—measured by a body mass index of more than 30—the requirement would be to lose 10% of their body weight within 12 months.”

Paula Sherriff MP

Speaking in a Westminster Hall Debate

Disabled women’s knee replacement operation cancelled due to BMI

In July 2018, Nina Parker, a disabled grandmother, was “devastated” to hear her knee operation was “axed in the cull on replacement surgery.” Nina Parker’s health has deteriorated badly and she now needs help with basic routines such as dressing and washing. Nina was due to have a double hip and knee replacement after suffering a fracture and being told by a GP the joints were “knackered”. However, after receiving her new hips, her knee surgery was cancelled because the CCG brought in a BMI threshold of 35. Her BMI was 36.

Her husband said: “We’ve been let down by the NHS and abandoned mid-treatment. The hip replacements are a waste of money as they are useless without knees to support them.”

https://www.mirror.co.uk/news/uk-news/disabled-gran-73-devastated-after-12986514

Patient denied access to life changing penile implant

For David (not his real name),  a 47-year-old engineer with erectile dysfunction and Peyronie’s disease, an abnormal curvature during an erection caused by fibrous scar tissue under the skin, the only option for a functioning love life is a penile implant. However, despite the devastating impact that the erectile dysfunction problems were having on his life, David was told the NHS would not pay the £4,500 cost of the implant. This forced David to take out a loan to have the operation done privately.

https://www.dailymail.co.uk/health/article-2295425/Peyronies-disease-Why-men-denied-surgery-revive-love-lives.html

Procedures of Limited Clinical Value

‘Procedures of Limited Clinical Value’ (or PolCV) traditionally referred to treatments that do not have sufficient data to prove their cost effectiveness or clinical benefit. It was originally applied to treatments such as alternative and complementary therapies and cosmetic procedures. Procedures included on these lists were generally not funded by NHS commissioners.[1]

However, commissioners are increasing using PoLCV as a way to control spending by limiting access to treatments and technologies that are proven to be effective. Ration Watch conducted analysis of all 195 CCGs to look at the types of procedures they include on PoLCV lists.

Ration Watch found a number of proven treatments included on PoLCV lists. Four of the treatments listed most frequently were – hernia repair, cataract removal, Constant Glucose Monitoring and hip and knee replacements. Most commonly with these procedures, CCGs are using access thresholds to limit patient access.

 HerniaCataract Continuous Glucose Monitoring Hip and knee replacement
Airedale, Wharfedale and Craven CCGXX
Ashford CCGXX
Barking and Daganham CCGXX
Barnet CCG
Barnsley CCGXXX
Basildon and Brentwood CCGXX
Bassetlaw CCGX
Bath and North East Somerset CCG
Bedfordshire CCGXXXX
Bexley CCG
Birmingham and Solihull CCGXXX
Blackburn with Darwen CCGX
Blackpool CCG
Bolton CCGX
Bradford City CCG
Bradford Districts CCG
Brent CCGXX
Brighton and Hove CCGXX
Bromley CCG
Buckinghamshire CCGXX
Bury CCGXX
Calderdale CCG
Cambridgeshire and Peterborough CCGXXX
Camden CCG
Cannock Chase CCGXX
Canterbury and Coastal CCGXXX
Castle Point and Rochford CCGXXX
Central London (Westminster) CCGXX
Chorley and South Ribble CCG
City and Hackney CCGX
Coastal West Sussex CCGXX
Corby CCGX
Coventry and Rugby CCGXX
Crawley CCGXX
Croydon CCG
Darlington CCGX
Dartford, Gravesham and Swanley CCGXXX
Doncaster CCGXXX
Dorset CCG
Dudley CCGXX
Durham Dales, Easington and Sedgefield CCGX
Ealing CCGXX
East and North Hertfordshire
East Berkshire CCGX
East Lancashire CCG
East Leicestershire and Rutland CCGX
East Riding of Yorkshire CCG
East Staffordshire CCGXX
East Surrey CCGXX
Eastbourne, Hailsham and Seaford CCGXX
Eastern Cheshire CCGXX
Enfield CCG
Erewash CCGXXX
Fareham and Gosport CCGXX
Fylde and Wyre CCG
Gloucestershire CCG
Great Yarmouth and Waveney CCGXX
Greater Huddersfield CCG
Greater Preston CCG
Greenwich CCG
Guildford and Waverley CCGXX
Halton CCGXX
Hambleton, Richmondshire and Whitby CCGX
Hammersmith and Fulham CCGXX
Hardwick CCGXXX
Haringey CCG
Harrogate and Rural District CCGX
Harrow CCGXX
Hartlepool and Stockton-on-Tees CCGX
Hastings and Rother CCGXX
Havering CCGXX
Herefordshire CCGXX
Herts Valleys CCGXXX
Heywood, Middleton and Rochdale CCGXX
High Weald Lewes Havens CCGXX
Hillingdon CCGXX
Horsham and Mid Sussex CCGXX
Hounslow CCGXX
Hull CCG X
Ipswich and East Suffolk CCGXXX
Isle of Wight CCGXX
Islington CCG
Kernow CCGXX
Kingston CCGX
Knowsley CCGX
Lambeth CCG
Leeds CCG
Leicester City CCGX
Lewisham CCGXX
Lincolnshire East CCGXXX
Lincolnshire West CCGXXX
Liverpool CCGXX
Luton CCGX
Manchester CCGX
Mansfield and Ashfield CCGX
Medway CCGXXX
Merton CCGX
Mid Essex CCGXX
Milton Keynes CCG
Morecambe Bay CCG
Nene CCGX
Newark and Sherwood CCGX
Newcastle Gateshead CCGX
Newham CCGX
NHS Berkshire West CCGXXX
NHS Bristol, North Somerset and South Gloucestershire CCGXXX
NHS South East Staffordshire and Seisdon PeninsulaXX
North CumbriaXX
North Derbyshire
North Durham CCGX
North East Essex CCGXX
North East Hampshire And Farnham CCGXX
North East Lincolnshire CCG
North Hampshire CCGXX
North Kirklees CCG
North Lincolnshire CCG
North Norfolk CCGXXX
North Staffordshire CCGX
North Tyneside CCG
North West Surrey CCGX
North, East, West Devon CCG
Northumberland CCGX
Norwich CCGXXX
Nottingham City CCGXX
Nottingham North And East CCGXX
Nottingham West CCGXX
Oldham CCGXX
Oxfordshire CCGX
Portsmouth CCGXX
Redbridge CCGXX
Redditch and Bromsgrove CCGXX
Richmond CCG
Rotherham CCGXX
Rushcliffe CCGXX
Salford CCG
Sandwell and West BirminghamXX
Scarborough And Ryedale CCG
Sheffield CCGXX
Shropshire CCGXXX
Somerset CCGXXX
South Cheshire CCGXXX
South Devon And Torbay CCG
South Eastern Hampshire CCG
South Kent Coast CCGXXX
South Lincolnshire CCGXXX
South Norfolk CCGXXX
South Sefton CCGXX
South Tees CCG
South Tyneside CCG
South Warwickshire CCGXX
South West Lincolnshire CCGXXX
South Worcestershire CCGXX
Southampton City CCGXX
Southend CCGXXX
Southern Derbyshire CCGX
Southport and Formby CCGXX
Southwark CCG
St Helens CCGXX
Stafford and Surrounds CCGXX
Stockport CCGX
Stoke on Trent CCGXX
Sunderland CCG
Surrey Downs CCGXXX
Surrey Heath CCGX
Sutton CCGX
Swale CCGXXX
Swindon CCG
Tameside and Glossop CCGX
Telford And Wrekin CCGXXX
Thanet CCGXXX
Thurrock CCGX
Tower Hamlets CCGX
Trafford CCGX
Vale Of York CCG
Vale Royal CCGX
Wakefield CCGXXX
Walsall CCGXX
Waltham Forest CCGX
Wandsworth CCGXX
Warrington CCGXX
Warwickshire North CCG
West Berkshire CCGXX
West Cheshire CCGXX
West Essex CCGXX
West Hampshire CCGXX
West Kent CCGXXX
West Leicestershire CCGX
West London CCGXX
West Norfolk CCGXXX
West Suffolk CCGXXX
Wigan Borough CCGX
Wiltshire CCGXX
Wirral CCGXX
Wolverhampton CCGXX
Wyre Forest CCGXX