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Is a ‘postcode lottery’ in health justified? Twitter hashtag: #NHSrationing.

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Presentation on theme: "Is a ‘postcode lottery’ in health justified? Twitter hashtag: #NHSrationing."— Presentation transcript:

1 Is a ‘postcode lottery’ in health justified? Twitter hashtag: #NHSrationing

2 Opening remarks and welcome Chair: Clare Marx, President, Royal College of Surgeons

3 Is a ‘postcode lottery’ in health justified? #NHSrationing WiFi: RCS-Public

4 Outline of the afternoon 16:40: Public attitudes towards rationing of NHS treatments and services. Ben Page, Chief Executive, Ipsos Mori 17:00: What can the NHS afford to provide: how do you make decisions about rationing and who is best placed to make these decisions? Chair: Sarah Neville, Public Policy Editor, Financial Times Nigel Edwards, Chief Executive, Nuffield Trust Dr David Jenner, Chair, Eastern Locality, NEW Devon CCG Dr Karol Sikora, Dean of Medicine, University of Buckingham Lord Warner, Labour Peer, ex health minister 17:55: Closing remarks Clare Marx, President, Royal College of Surgeons 18:00: Drinks reception (in the Council room down the corridor) 4

5 Context of this debate The NHS faces significant financial pressures £30bn funding gap by 2020/21, according to NHS England £5.3bn integrated care fund is a good initiative but may cause pressure on acute budgets in short-term The need to tackle inefficiency and waste Tariff uncertainty Meanwhile demand continues to increase Latest HES data shows 2.5% increase in number of episodes of care from previous year Historically the NHS has sought short-term savings by arbitrarily cutting services The RCS has monitored these decisions 5

6 Rationing of specific procedures In 2014 we collected commissioning policies for 5 procedures from 54 CCGs Tonsillectomy Cholecystectomy Hip replacement Hernia repair Surgical treatment of otitis media with effusion We compared these policies with available NICE guidance and clinical guidance from the RCS and Surgical Specialty Associations (SSAs) 6

7 Key findings from our report 73% of CCGs reviewed do not follow NICE guidance on referral for hip replacement or have no policy in place 44% of CCGs had imposed different pain thresholds (Oxford Score) for hip replacement contrary to NICE and clinical guidance Only 27% of CCGs complied with NICE or surgical guidance on inguinal hernia repair 77% of CCGs did not follow clinical guidance on the commissioning of treatment for glue ear Two CCGs had minimum “watchful waiting” periods meaning some patients may not access tonsillectomies for a year and a half 7

8 The case of NEW Devon CCG facing cumulative deficit of £43.7m CCG said “urgent and necessary” measures were required to redress the situation. BMI (35) threshold for elective activity Patients over threshold required to undergo 6 month weight loss programme funded by the CCG Smokers to quit 6 weeks prior to surgery 8

9 CCG under intense scrutiny Pressure from the RCS “It is unacceptable for any CCG to have a blanket ban on elective surgery for people above a certain weight” Pressure from NHS England Simon Stevens, appearing at the Health Committee, said: “frankly, we do have some reservations about the particular approach that is being proposed there” Pressure from the Government? At a parliamentary debate on events at NEW Devon Jane Ellison said: “Today I had a telephone discussion with some of the key people involved, including the chief officer of the CCG...” The proposals were dropped shortly after that phone conversation… 9 Jane Ellison, the Public Health Minister

10 NEW Devon as the canary in the NHS coalmine? The case of NEW Devon is representative of the real challenges commissioners are facing Are the CCG’s actions not just a reaction to the realities of their situation? They are not alone: FDS research shows that some commissioners are refusing to provide dental implants, including to cancer patients There is on going debate over which drugs to fund on the NHS (eg in Cancer) 10

11 What does this mean for patients? Delayed treatment can result in poorer outcomes and is distressing for patients. In rare cases it may also expose the patient to greater risk of medical emergency E.g. strangulated hernia Conservative measures don’t necessarily fix the underlying problem Pain relief doesn’t overcome the need for a new hip due to osteoarthritis But isn’t there a need to allocate resources fairly? 11

12 Questions for today If local commissioners choose different levels of service provision should there be: A safety net of care provided? A process for dialogue between commissioners, patients and clinicians? The role of NICE Should its guidance be mandatory? Should it be above political influence? Should we abdicate all responsibility and leave it all to the politicians? 12

13 Public attitudes towards rationing of NHS treatments and services Ben Page, Chief Executive, Ipsos MORI

14 What can the NHS afford to provide: How do you make decisions about rationing and who is best placed to make these decisions? Chair: Sarah Neville, Public Policy Editor, Financial Times Nigel Edwards, Chief Executive, Nuffield Trust Dr David Jenner, Chair, Eastern Locality and Mid Devon sub-locality, NHS Northern, Eastern and Western Devon Clinical Commissioning Group Professor Karol Sikora, Dean of Medicine, University of Buckingham The Rt Hon. the Lord Warner, Peer, House of Lords

15 Closing remarks Chair: Clare Marx, President, Royal College of Surgeons

16 Thank you Thank you for participating. Please join us for drinks and canapés in the Council room.


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