Healthwatch Enfield asks clinical commissioning group to reconsider rationing of medical procedures

Dr Mo Abedi
Chair, NHS Enfield Clinical Commissioning Group
Holbrook House
Cockfosters Road
Barnet
EN4 0DR

via e-mail

Dear Dr Abedi,

Re: NHS Enfield Clinical Commissioning Group (ECCG) Consultation on Adherence to Evidence Based Medicine for Procedures of Limited Clinical Effectiveness

At Healthwatch Enfield, it is our job to amplify voices of local people on key issues that affect them; over the last few weeks we collected over 100¹ instances of feedback relating to NHS Enfield Clinical Commissioning Group (ECCG) Consultation on Adherence to Evidence Based Medicine for Procedures of Limited Clinical Effectiveness.

In relation to the proposals by the ECCG to change clinical criteria for patients to access the following treatments: Bunions² ; Hearing Aids; Hernia³ ; Vasectomy (male sterilisation)⁴; Uterovaginal Prolapse⁵ ; Revision Mammoplasty (breast reconstruction); Revision of hypertrophic scars, skin graft for scars⁶ ; Penile Procedures (Penile Implants); Cholecystectomy for Gallstones⁷ ; Chalazions (Internal Stye or Meibonian Cyst)⁸ ; Correction of Ptosis⁹ ; to introduce new criteria to access Knee Replacement Surgery; and to de-commission Homeopathy services, local people told us:

• on limiting access to hearing aids, we heard that the proposals:
  • ‘don’t seem to make sense as they discriminate between those whose hearing loss is due to infectious diseases and those whose hearing loss is due to other causes such as Menière’s’
  • ‘will cost NHS more money. How would I be able to communicate with my GP or consultant over the phone if I didn’t have a hearing aid? How will I know if someone is calling me to arrange an appointment?’
  • ‘will put people at risk. What would happen if you don’t hear oncoming traffic when you’re crossing the road’
  • ‘will affect those who are elderly and already tackling social isolation. It would be impossible for me to communicate with anyone if I can’t hear them properly. I may as well commit myself to my house now cause what’s the point?’
  • ‘don’t consider other ways of making savings. Why not offer the hearing aids but stop paying for the batteries? In here, the batteries became a commodity as people had stacks of them’
• on limiting access to revision mammoplasty, ‘did anyone consider what impact this can have on women?! Who is going to help them with depression? With ensuring they feel confident enough to leave the house?!’
• on introducing new criteria to access knee replacement, many people told us ‘I can’t believe NHS is proposing such things. Pain so severe I can’t sleep at night? I thought the NHS was here to make me feel better and look after me – not make me suffer! And what would be the impact of me constantly taking pain-killers? Would I need another treatment that is no longer available on the NHS?!’

Having been advised that similar consultations will be carried out in the boroughs of Barnet, Camden, Haringey and Islington, many people expressed their concerns about ‘being yet again subjected to postcode lottery. It seems there will be nothing left in Enfield.’

Of the 102 people we heard from at Mendip House, the Over 50’s Fellowship Club and the Riverside supported living scheme, none of them were aware of the ECCG proposals and consultation prior to their engagement through Healthwatch Enfield. Having been provided with a copy of the papers issued by ECCG, as part of the consultation process, the individuals told us ‘the document’s well-nigh incomprehensible to the layperson even though it’s ostensibly aimed at securing input from non-medically qualified users of the service’.

All Enfield residents we heard from, explicitly stated that they did not support any of the proposals, other than decommissioning homeopathy services, for new access criteria under the consultation on Adherence to Evidence Based Medicine for Procedures of Limited Clinical Effectiveness. Having learnt that changing the clinical criteria to access certain treatment would save NHS Enfield Clinical Commissioning Group around £400,000 to £500,000 a year, people proposed ‘that this level of savings could be achieved through getting rid of a few people working there as opposed to taking away treatments we always had’.

Several people contacted Healthwatch Enfield about the Equality Impact Assessment, which forms part of the pack for the consultation on Adherence to Evidence Based Medicine for Procedures of Limited Clinical Effectiveness, expressing their concerns that ‘Nature of potential impact’ of ECCG’s proposal is unknown.

We were also contacted by the Royal London Hospital for Integrated Medicine, which provides alternative therapies including homeopathy to NHS patients including Enfield residents: ‘the Hospital has been served a notice of intent to decommission (homeopathy) services from Enfield CCG, but had not been made aware of the ongoing consultation about Adherence to Evidence Based Medicine. How can the consultation be genuine when it appeared that the CCG had already decided to decommission this service, although the consultation has not yet closed? None of the patients who use this service have been contacted to let them know that the consultation is taking place.’ We note that we received this response and have included it, even though it is from an institution, as it may reflect the views of some patients.

Using the evidence base collected and with our explicit remit to amplify individuals’ voices at strategic levels, Healthwatch Enfield recommends that NHS Enfield Clinical Commissioning Group suspends any decision-making following its initial consultation on Adherence to Evidence Based Medicine for Procedures of Limited Clinical Effectiveness whilst it gives due consideration to local people’s response that no cuts should be made. We ask NHS Enfield Clinical Commissioning Group to work with local people and providers to co-produce¹⁰ services that meet individuals’ needs.

We look forward to hearing from you with the outcomes of NHS Enfield Clinical Commissioning Group’s Consultation on Adherence to Evidence Based Medicine for Procedures of Limited Clinical Effectiveness.

Yours sincerely,

Patricia Mecinska
Chief Executive

Deborah Fowler
Chair

Footnotes

1. This is in addition to NHS Enfield Clinical Commissioning Group’s commissioned event organised by Healthwatch Enfield on 22nd March 2017
2. A bunion is a bony deformity of the joint at the base of the big toe.
3. A hernia occurs when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall
4. During a minor operation, the tubes that carry sperm from a man's testicles to the penis are cut, blocked or sealed.
5. Bulging of one or more of the pelvic organs into the vagina
6. Hypertrophic scars are red and thick and may be itchy or painful. They do not extend beyond the boundary of the original wound, but may continue to thicken for up to six months.
7. Gallbladder removal surgery, also known as a cholecystectomy, is a very common procedure. The gallbladder is a small, pouch-like organ in the upper right part of your tummy. It stores bile, a fluid produced by the liver that helps break down fatty foods.
8. A stye is a small, painful lump (cyst) on the inside
9. Ptosis is a drooping or falling of the upper eyelid.
10. Co-production improves health and produces consequent savings: http://www.nesta.org.uk/sites/default/files/the_business_case_for_people_powered_health.pdf