Below are the latest proposals from Devon NHS for cuts and rationing of services because of what they describe as the worsening financial deficit. For those who haven’t followed this in detail, my first reading of it is that they are tightening the restrictions of operations for people who smoke or who are overweight and extending it to all operations not just hips and knees. It will be interesting to see what the Royal College of Surgeons has to say about this given their strong condemnation of the original less severe proposals.
Health bosses seem to have backed down from their proposal to stop all IVF treatment. (NICE guidance says infertile couples should be able to expect at least 3 courses). They have also backed down on their proposed restrictions to Caesareans. They appear to be proceeding with other restrictions including providing cataract operations and hearing aids to just one eye or ear.
The Government are still in total denial about the crisis in the NHS in general and in Devon in particular, as my exchange with Jeremy Hunt this week in the Commons on the scandal of the young girl with mental health problems locked in a police cell in Devon shows.
Letter from NEW Devon CCG - 3 December 2014
Dear Mr Bradshaw
Re: Urgent and Necessary Measures
As a key stakeholder I am writing to update you about the initial decisions on the Urgent and Necessary Measures we are taking to address a worsening of the CCG’s financial situation. The decisions are being announced this afternoon at our Governing Body and I wanted to make sure you had the opportunity to receive information before it is communicated publicly.
As you will be aware, last year the CCG returned a £14.5 million deficit (known as the control total) and this year we have been predicting the same.
You will also be aware that our confidence in meeting the control total at the end of the current financial year has gradually declined as demand for services continues to outstrip what we can afford. Dealing with this is vital to protect essential services particularly through our busiest winter months.
We told you previously that we were considering and reviewing a series of temporary measures designed to improve efficiency in the system and to encourage patients to contribute to improving their own health outcomes. They have now been considered and reviewed by our lead clinicians.
The decisions we have taken will allow us to continue prioritising those services and requirements laid out in the NHS Constitution.
They include (but are not limited to):
- Consultant-led treatment within a maximum of 18-weeks from referral for non- urgent conditions
- Maximum four-hour wait in A&E from arrival to admission
- Maximum seven day wait for follow-up after discharge from psychiatric in-patient care
- Being seen by a cancer specialist within a maximum of two weeks from GP referral where cancer is suspected
- Maximum 62-day wait from referral from an NHS cancer screening service to first treatment
- Patients waiting for a diagnostic test should have been waiting less than six weeks from referral
- Ambulance trusts to respond to 95 per cent of category A calls within 19 minutes of a request being made.
The evaluation considered the effectiveness, cost and the impact of suspending services. A range of criteria has been developed to support this judgement with contributions from GP practices, Patient Participation Groups and other patient and community interest groups.
Last month the CCG announced its intention to take ‘urgent and necessary’ measures to prioritise the requirements laid out in the NHS Constitution. The CCG decided that for those patients undergoing hip and knee operations with a body mass index of more than 35 (morbidly obese) that the patient would be required to have a BMI of under 35 or to lose 5 per cent of their weight before planned surgery, whichever is the lesser weight loss.
The CCG announced today that it would be temporarily extending the BMI requirement to all surgical procedures. It also said it would extend the quit smoking requirement from the original proposal of six weeks to eight weeks before surgery.
In all cases the decisions announced are interim commissioning positions based on clinical evidence, pending further consultation. They have also been subject to quality and equality impact assessments. The quit smoking and the BMI requirements will be introduced with immediate effect. Patients with a date for surgery will not be affected. All other patients that are covered by the policy will be offered weight management or quit smoking support
The areas of service we have decided to change are:
- Requiring patients who have a BMI of over 35 to lose 5% of their weight or to get to under BMI 35 before planned routine surgery, whichever is the lesser weight loss
- Requiring patients to stop smoking for at least eight weeks before planned routine surgery
The drugs we are choosing to use to treat Wet Age-Related Macular Degeneration (Wet AMD)
- Shockwave therapy for tendon problems and bursitis
- Certain types of shoulder surgery
- Removal of earwax by in hospitals
- Treat cataracts in each eye separately. Treatment will be to DVLA standard for drivers and 6/12 for non drivers
- Provide one hearing aid as the norm
More information on these measures including a series of patient information leaflets can be found on our website, www.NEWDevonCCG.NHS.UK under the About Us tab. The leaflets will also be made available for GP surgeries and local hospitals.
The review also concluded that a small number of measures were not suitable to take forward at this stage:
- Suspension of IVF treatments: this has been assessed and deemed not suitable for a rapid decision as an Interim Commissioning Position
- Restrict elective caesarean without medical grounds
Other measures are still being considered some will be for the longer term but some will be announced in the coming months. We anticipate that there will be further measures for a full or partial suspension identified during December and for implementation from January. We will contact you again when we have further details on those.
We are committed to being open about what we are considering and how the decisions are being made. We are publishing our decisions and producing information for the patients affected about the available treatment options for them.
Chief Officer - Northern, Eastern and Western Devon Clinical Commissioning Group