Against the backdrop of growing disquiet about the ability of the NHS in England to cope, local campaigners are questioning Enfield's health commissioning body about its plans to cut back on the types of surgical procedures that will be available from the NHS.
While attention nationally has been focused on accident and emergency departments that are struggling to meet demand, Defend Enfield NHS this week has been concerned with proposals to reduce NHS provision of non-emergency (so-called "elective" or "planned") surgery for the borough's residents. The group has written to Enfield Clinical Commissioning Group (CCG) seeking to clarify how it intends to proceed.
The CCG policy in this area is referred to as the Adherence to Evidence Based Medicine Programme (previously called “Hard Choices”). The overall concept is that the CCG should no longer pay for certain clinical procedures where the "net benefit" to patients is low, including, but not limited to, "procedures of limited clinical effectiveness".
The initial list of procedures under review comprises:
- Hips & Knees
- Hernia
- Hearing Aids
- Bunions
- Haemorrhoids
- Vasectomy
The review work looks at the "thresholds". In other words, some patients with for instance hip or knee problems would not be treated because their problems were not assessed as sufficiently serious. The intention is to add more procedures to this list.
While Defend Enfield NHS do not quarrel with the need to keep under review the effectiveness of all types of elective surgery, their concern is that in this case there is a risk that Enfield CCG's urgent need to reduce its spending (the result, according to DENHS, of inadequate government funding) will take precedence over objective clinical decision-making and the needs of patients.
In a letter to the CCG, Dr Martin Blanchard of DENHS asked the CCG how it will ensure that the 30-day consultation would be publised to the whole of the borough's population. He was also concerned about potential inequalities arising between those who could afford to pay privately and those who could not:
"Will the CCG monitor the effects the Adherence programme may have on inequality of health care in the local health economy? Such inequality of health care may be brought about by people who, having assessed the “NHS offer” as inadequate, then resort to private intervention if they can afford it. If this is not seen by the CCG as an inequality because what is offered by the NHS is “Evidence Based”, then is the Adherence to Evidence Based Medicine Programme rigorous enough to form the basis for any legal action taken by a private patient with a grievance who has been treated where “Evidence Based” procedures have not been followed?"
As it is, Enfield CCG already stipulates that GPs in the borough cannot refer patients direct to hospital specialists for elective surgery. Referrals have to go via an intermediary body, the Enfield Referral Management Service (ERS), which introduces delays. The British Medical Association has criticised the use of such referral services, which they say causes "dangerous" treatment delays and a "block between the GP and patient treatment".
