On Wednesday 22nd August, NHS England (NHSE) held a public discussion in Leeds Town Hall on restricting access to 17 different medical interventions, including surgery for common hand problems, varicose veins, tonsillectomy and other conditions.
Although an important national consultation on major changes in NHS provision, poor advertising and summer holidays meant it was attended by only a handful of people. The supposition behind the proposals is that doctors thoughtlessly recommend surgical interventions that are neither effective nor safe to hundreds of thousands of patients each year.
While there are excellent evidence based guidelines already available for who should have these treatments, clinicians must be compelled to make special funding requests for individual patients, and hospitals told they will not be paid for activity, in order to bring them into line with NHSE designated ‘best practice’.
The Royal College of Surgeons objects to interventions that improve quality of life and reduce pain being designated as ‘low value’, pointing out that not treating some conditions may lead to much more costly complications later on.
Revealingly, the current limited list of ‘low value interventions’ echoes that drawn up by management consultants McKinsey when asked after the 2008 banking crisis how the NHS could save money. NHSE plans to expand rapidly beyond the current list of 17 restricted treatments.
The public need to be aware that this process fundamentally changes the way the NHS works and strikes at the heart of the doctor patient relationship, where clinicians assess a patient’s needs and wants, recommending treatment based on sharing evidence of risks and benefit.
The current projected savings are minute (0.16% of NHS budget), but a key objective of NHSE is to establish that the NHS will no longer provide some treatments, and you wont be able to have these unless you pay to go privately. I would encourage your readers to visit the NHSE website (https://bit.ly/2uNYQOg) and feedback their views through the ‘consultation on evidence based interventions’.
Dr John Puntis
Leeds Keep Our NHS Public