RESTRICTING CLINICAL FREEDOMS
PrEP rationing is symptomatic of NHS bid to cut costs, at all costs (The Guardian: 2 August 2016)
NHS England’s setback in the high court over its attempt to get one set of cash-strapped public bodies (local councils) to foot the £10m-£20m a year bill for PrEP treatment rather than another – itself – is the latest manifestation of the health service’s increasing efforts to reduce the number of treatments it pays for, or the number of patients who receive them, or both.
Gradually, and largely unacknowledged, the NHS is rationing access to more and more types of care in order to try to balance its books, even when doing so includes treatments – such as PrEP, with its 90% success rate – that are proven to work but deemed prohibitively expensive in the midst of its decade-long funding squeeze.
Doctors, patients and health charities routinely insist that lives will be lost as a result, but still the process rolls on, affecting different groups of patients every time a decision is made....read more
Cash-strapped hospitals face 'unpalatable' choices over care levels, warns NHS chief (http://www.itv.com: 11th September 2016)
The NHS is close to breaking point and hospitals will have to make "unpalatable" decisions about care levels and jobs, unless the they receives more funding, the head of one of the service's largest trade bodies has warned.
In a number of media appearances on Sunday, Chris Hopson, the head of NHS Providers, warned that without further funding the NHS would need to consider greater rationing of care, staff layoffs and a relaxing of targets.
Writing in The Observer, he said the health service was "increasingly failing to do the job it wants to do, and the public needs it to do, through no fault of its own", and said there was a need for "an open, honest, realistic, national debate on what gives" if no more money is made available…Read More
NHS 'abandoning' thousands by rationing hepatitis C drugs (The Guardian: 28 July 2016)
NHS England has been accused by a charity of “abandoning” thousands of people to a potential death sentence by rationing drugs that can cure hepatitis C.
An estimated 215,000 people in the UK have chronic hepatitis C infection (160,000 in England), which new but costly drugs can cure. Addaction, a charity that helps people overcome drug and alcohol abuse, says the decision to treat 10,000 people a year is “manifestly unfair”.
Addaction is backing a judicial review application brought by another charity, the Hepatitis C Trust, over NHS England’s decision to cap the annual numbers on cost grounds.
“The decision by NHS England to limit access to treatment is manifestly unfair on a group of vulnerable people who suffer from a terrible disease,” said Simon Antrobus, chief executive of Addaction. “Those who are infected can go on to develop cirrhosis of the liver and liver cancer. Denying these people life-saving treatment is a potential death sentence for thousands.”
The National Institute for Health and Care Excellence (Nice) has recommended treatment of people with hepatitis C with the new drugs. NHS England first asked for a three-month delay in implementing the guidelines and then capped the numbers it would treat, so that only the sickest get the drugs immediately....read more
GPs told to ignore NICE statin prescribing guidance in cost-cutting drive (Pulse: 2 June 2016)
GPs have been told to ignore current NICE lipid modification guidelines on statin prescribing in low-risk people, under a cost-saving policy at one CCG.
NHS Stockport CCG has advised GPs should only prescribe statins to people if they are found to be at a 20% or greater risk of cardiovascular disease – and not at the lower NICE-recommended threshold of 10%-20%.
The CCG has also stipulated that GPs should prescribe simvastatin first-line rather than the NICE-recommended lipid-lowering drug atorvastatin, as part of measures to control spending.
NICE condemned the decision, which it said meant people were being denied the opportunity to lower their risk of a disease that 'maims and kills one in three'.
The GPC said that the CCG's decision was 'strange' and 'born out of desperation'....read more
NHS England stalls plans for HIV prevention drug (The Guardian: 21 March 2016)
Charities and campaigners have reacted with anger and disbelief that plans to roll out a widely anticipated HIV prevention drug have been stalled by NHS England.
The sector had been waiting for the announcement of the first ever public consultation on the use of pre-exposure prophylaxis (PrEP) in the UK, now overdue by a month. Instead today NHS England announced it was not their responsibility to commission the drug.
The HIV treatment pill Truvada containing PrEP can be taken on a daily basis – in a similar way that women take the contraceptive pill – by men who have sex with men to dramatically reduce the risk of HIV transmission. In February 2015, a Proud (pre-exposure option for reducing HIV in the UK: immediate or deferred) study reported that PrEP had effectively reduced the risk of HIV infection by 86%.
Terrence Higgins Trust, the largest provider of HIV and sexual health services in the voluntary sector, expressed shock and disbelief as structured plans for introducing the drug were shelved...read more
NHS rationing 'is denying patients care' as cash crisis deepens (The Guardian: 8 December 2015)
Patients are being denied mental health care, new hips and knees, and drugs to boost their recovery from illnesses including cancer as the NHS increasingly rations treatments to try to overcome its growing cash crisis.
A survey of doctors reveals that three-quarters said they had seen care rationed in their area over the last year – including treatments such as speech therapy, operations to remove varicose veins, Botox to help children with cerebral palsy move better and even potentially life-saving stem cell transplant surgery.
Disabled children were having to use ill-fitting wheelchairs, teenage girls were banned from accessing medication to tackle male-style hair growth and women had been unable to access surgery to have breast enlargements or reductions as a result of growing restrictions across England, the research concluded.
Medical organisations said the findings showed patients were paying the price because an underfunded NHS was having to force them to wait for care or deny it altogether...read more
Breast cancer drug Kadcyla 'too expensive' for NHS (BBC: 16 November 2015 )
A life-extending breast cancer drug will not be routinely offered on the NHS in England and Wales because it is still too expensive, says a watchdog. Women in England will be able to get Kadcyla through the Cancer Drugs Fund, but the price tag per patient - £90,000 at full cost - is too high to widen access, say the draft NICE guidelines. NICE criticised manufacturer Roche for not making it more affordable. Roche says discussions are continuing, meaning a resolution is still possible. Kadcyla can add about six months of life to women with incurable disease. It is used to treat people with HER2-positive breast cancer that has spread to other parts of the body and cannot be surgically removed.
Roche, recently agreed a significant price discount with NHS England to stop the drug being taken off the Cancer Drugs Fund - a special fund set up by the government to help people in England access costly cancer drugs that are not routinely available on the NHS.
But the Swiss pharmaceutical company offered a different, smaller discount to NICE for regular NHS use of Kadcyla (Trastuzumab Emtansine) in England and Wales. NICE says this undisclosed figure is still too high to justify against the drug's clinical merits. Any person currently receiving the treatment can continue until they and their doctor consider it appropriate to stop, however....read more
Exclusive: Nearly a third of CCGs consider rationing services (HSJ: 3 September 2015)
Nearly a third of clinical commissioning groups have implemented or are considering restrictions to services this year, HSJ research reveals: almost a third of CCGs have implemented or are considering restricting access to services; CCGs are making joint decisions in their region on procedures of “limited clinical value”; and commissioners have brought in limits amid financial pressures.
HSJ sent freedom of information requests to all 209 CCGs asking whether they had introduced or planned limits to access or eligibility for services during 2015-16 for financial, efficiency or value reasons. Thirty-four CCGs said they had introduced or approved restrictions, out of the 188 groups that responded. Thirty-three said they were considering changes or that their plans were under review. The research found that neighbouring CCGs have tended to make joint or similar decisions, particularly on procedures deemed to be of “limited clinical value”.
For example, all CCGs across Nottinghamshire, except Bassetlaw, have agreed to a joint commissioning policy on such procedures. The document lists a raft of treatments, including surgery for sleep apnoea and hysterectomy for heavy menstrual bleeding, which the groups say “can only be paid for by the local NHS in certain restricted circumstances”.
Seven CCGs across Birmingham, the Black Country and Solihull are also developing a single set of agreed clinical commissioning policies and in the South West, Bristol and South Gloucestershire, CCGs agreed in June to new policies to restrict access to acupuncture, adenoidectomy and post-operative physiotherapy, which will be implemented once local trusts agree to the contract changes.
North East Essex also plans to bring in thresholds for non-urgent elective surgery on the basis of whether patients smoke or are overweight, while Mid Essex is considering changes to continuing healthcare.
Decisions to ration services have faced opposition. In March, North Staffordshire became the first CCG in the country to restrict access to NHS funded hearing aids, which it said would save £200,000 in the first full year. The charity Action on Hearing Loss warned it was the “thin end of the wedge” for wider charging for NHS services by CCGs, but the plans were backed by NHS England, which said the group had followed “proper process” and made an evidence based decision.
GPs face increasing restrictions as NHS rations care to save money (Pulse: 30 July 2015)
Exclusive GPs face increasingly tighter restrictions on their ability to refer for specialist care, reveals an investigation by Pulse into plans drawn up by the most cash-strapped CCGs in the country.
The investigation reveals that CCGs are introducing policies that cap surgical referrals, require overweight patients to go a on a ‘weight loss programmes’ before an operation and deny hard-of-hearing patients hearing aids and audiological care.
The investigation comes as GPs say they are finding it harder to refer for surgical treatment of conditions like ganglions or carpal tunnel and, in one area, requests for hysterectomies are simply being ‘fobbed off with a Mirena coil’.
More than a third (36%) of GPs told Pulse they are facing new constraints on services to which they were previously able to refer.
The investigation comes as the health service prepares to implement £22bn of efficiency savings by 2020. But only two years after coming into existence, 19 CCGs have been ordered by NHS England to devise emergency plans to cut their budget deficits.
Obese patients denied surgery by NHS rationing (GP: 10 June 2015)
GP leaders slammed the ‘rationing’ of NHS services and warned that the restrictions on access to care appeared to breach the NHS Constitution.
NHS England’s national commissioning criteria for bariatric surgery could prevent GPs from referring patients for bariatric surgery in line with NICE guidance.
The NICE clinical guideline Obesity: Identification, assessment and management of overweight and obesity in children, young people and adults was issued in November 2014.
It recommends bariatric surgery as a treatment option for patients with obesity if they ‘have a BMI of 40kg/m2 or more’ or a BMI ‘between 35kg/m2 and 40kg/m2 and other significant disease’.
It adds that ‘all appropriate non-surgical measures have been tried’ and the patient ‘has been receiving or will receive’ intensive management in a 'tier three' service.
The NICE guidance does not impose any time restrictions on access to care. But NHS England’s commissioning policy stipulates that the patient must have ‘received and complied’ with a tier three or four weight-loss management service ‘for a duration of 12-24 months’ in order to qualify for bariatric surgery. It also dictates that the patient must have been morbidly obese – BMI 40 or higher – ‘for at least five years’ to be eligible for the potentially lifesaving treatment.
NHS vasectomies rationed as health service forced to make cuts (Daily Mirror: 25 May 2015)
Free vasectomies are being rationed in some parts of the country, as the NHS is forced to cut costs.
One commissioning group has told GP practices to cap the number of snips offered to patients.
Each surgery in Basildon and Brentwood, in Essex, has been sent a letter assigning them a specific amount of vasectomies for the 2015/2016 financial year, ranging from 11 to one.
Three surgeries are believed to have been told they can refer just one man a year for the procedure, which is a permanent method of contraception.
NHS to 'extend rationing' of healthcare in bid to balance books (The Guardian: 21 April 2015)
The NHS plans to dramatically increase rationing of patients’ access to care and treatment in an effort to balance its books, a new survey of health bosses reveals.
Almost two in five of England’s 211 clinical commissioning groups (CCGs) are considering imposing new limits this year on eligibility for services such as IVF, footcare and hip and knee replacements.
Smokers and those who are obese will be among those denied surgery and other treatment, according to a survey of 80 CCG leaders conducted by the Health Service Journal, in an extension of the controversial policy of “lifestyle rationing”.
Chief executives, chairs and board members at 67 CCGs were asked: “Is your CCG considering introducing new limits to access/eligibility for services during 2015/16, for financial/efficiency/value reasons?”. Among the respondents, 39% said yes, 57% said no and 4% did not know.
NHS will be forced to ration care if current 'penny-pinching' continues, BMA chief warns (The Guardian: 3 April 2015)
The NHS will have to ration care if the incoming government does not give it enough money to do its job properly, Dr Mark Porter has warned.
The head of the British Medical Association also contradicted the coalition’s claims that it has given the NHS in England real-terms annual increases in its funding every year since 2010.
Recent “penny-pinching, parsimonious” moves by some parts of the NHS to restrict cataract surgery and hip and knee replacements are a taste of how the service responds to a shortage of money, the British Medical Association boss said.
NHS cash pressures causing bad rationing decisions (On Medica: 19 February 2015)
The NHS is starting to make unfair and inappropriate decisions on rationing healthcare in England due to growing financial pressures on the health service, according to a leading health think tank.
The Nuffield Trust has today published a briefing paper Rationing in the NHS aimed at current and prospective MPs in which it warns that there is a growing lack of legitimacy in the way many rationing decisions are being made.
A Nuffield Trust survey of 100 health and social care leaders, also published today, has found that more than a third of respondents feel the current approach to rationing healthcare is unfair and 7 in 10 want the Cancer Drugs Fund to be wound up.
Eight cancer drugs to be denied on NHS (The Telegraph: 8 January 2015)
Thousands of cancer patients will be denied NHS drugs following a decision to withdraw funding for at least eight life-extending treatments.
Medication which offers a last chance to patients with breast, prostate and bowel disease will no longer be funded by the NHS, under plans to cut spending.
Ahead of the last election, the Conservatives pledged to introduce a Cancer Drugs Fund so that cancer patients were no longer denied drugs on the grounds of cost.
But the £200m fund, introduced in 2011, has overspent its budget, despite the fact it was increased to £280m, leading to a review of 25 drugs which are used in 42 treatments.