Cameron’s forgotten patients

This is NHS Check report no 4 originally published by Labour’s Shadow Health Team in  November 2012

Revealed:

• An estimated 52,000 patients in England were denied treatment and kept off NHS waiting lists last  year due to cost-based restrictions
• Official statistics show huge fall in operations in the eight treatments most commonly subject to new restrictions
• Overall, 47 PCTs in England have restricted one or more of the eight treatments
• Patients left in pain, discomfort, unable to work or paying to go private as cataract, varicose vein and carpal tunnel syndrome operations all affected
• Evidence of accelerating postcode lottery across nhs in england undermines claims by ministers that rationing by cost is not happening

KEY FINDINGS

The table below shows the impact of restrictions imposed since the election:

• These figures for hospital episode statistics (HES) for patients admitted to hospital, analysed by the House of Commons Library, show a fall of 51,815 across all eight most commonly restricted treatments.
• These are the first falls for many years in numbers of operations – against a background of growing demand.
• Labour’s NHS rationing survey in June showed almost half of Primary Care Trusts or Clinical Commissioning Groups have restricted or decommissioned services in the years 2010-11 and 2011-12. It found 125 different services had been rationed across the NHS, with 22 being entirely stopped in some parts of the country.
• Of the 100 respondents found to be restricting access to the above treatments in June:
  • 24 PCTs restricting tonsillectomy
  • 21 PCTs restricting varicose veins treatment
  • 16 PCTs restricting cataract referral
  • 14 PCTs restricting Dupuytren’s contracture
  • 14 PCTs restricting surgery for carpal tunnel syndrome
  • 14 PCTs restricting skin tag removal
  • 13 PCTs restricting myringotomy
  • 13 PCTs restricting hysteroscopy

Clinical commentary on restricted treatments:

Cataracts

Cataracts imply declining sight which can be an enormous problem for elderly people and is responsible for falls and injuries requiring hospital treatment.  Such absolute restrictions have no clinical imperatives.  There is now evidence that early cataract surgery is beneficial to patients, and the over reliance of Visual Acuity as a measure is outdated.  Delaying surgery leads to more ophthalmic complications, making surgery more risky, and in the event proves costlier.

Varicose veins

30% of adult population will develop varicose veins at some stage of their life.  5-10% of the population will develop complications or troublesome symptoms such as eczema or ulcers interfering with the life style.

Carpal tunnel syndrome

Carpal tunnel syndrome is a constriction of ligaments in the wrist affecting the nerves and can be painful and disabling.  There is still access to surgery but it is being made more difficult to obtain.  It must be assumed that this is on grounds of cost rather than efficacy.

Tonsillectomy

Accepting the de facto evidence that tonsillectomy abolishes attacks of tonsillitis, consider an adult having three attacks of tonsillitis per year, aged of 30, who elects to have a tonsillectomy.  The operation costs about £720.  The primary care consultation and prescription costs for antibiotics and painkillers are close to the index cost of the operation.

Dupuytren’s contracture

Dupuytren’s contracture means a restriction on people’s normal use of their hand.  This is a planned operation, but where the contractures are severe even undertaking basic tasks such as making a cup of tea or a meal are impaired.  Surgery is indicated where other methods have failed; any delay will make the contractures get progressively worse, and it is likely then that at some stage surgery will no longer be possible.

Myringotomy

Myringotomy and grommet insertion is performed to allow air to circulate freely in the middle part of your ear. This is usually performed to help with hearing loss due to fluid in the middle ear or relieve pain due to poor air flow in the middle ear.  Any restriction of surgery on a child who has been deemed to require this procedure will undoubtedly affect their development and ability to concentrate in school, and cause long-term harm.

Hysteroscopy

A hysteroscopy can be used to help diagnosis cases where a woman’s symptoms suggest that there may be a problem with the womb. Symptoms might include:

• heavy or irregular periods
• bleeding in between normal periods
• pelvic pain
• unusual vaginal discharge
• repeated miscarriage
• infertility

A hysteroscopy can also be used to remove abnormal growths from the womb.

BACKGROUND

In June, Labour’s first NHS Check supplied the lists of bureaucratic restrictions that had been ushered in around the country – crude cost-cutting as the Government cut the NHS budget two years running. That report detailed the PCTs imposing restrictions and the nature of the treatments being restricted.  Today’s report shows the human impact that the rationing of these treatments is having.

In 2011 the then Health Secretary Andrew Lansley announced that he was banning Primary Care Trusts from rationing operations on grounds of cost.

“PCTs have to manage resources carefully but they must do so without restricting patient choice. That’s why I am taking firm action today and banning these unfair measures imposed on patients.”

Department of Health press release, 14 November 2011,

When presented with the evidence of rationing based on cost Ministers denied the existence of some of the restrictions and denied the impact of others.

The former Secretary of State, Andrew Lansley said:

“Time and again, he (Andy Burnham) says, ‘Oh, they are rationing.’  They are not.”

Andrew Lansley, Annual Report to Parliament on 4^th July 2012, House of Commons Hansard, 4 July, c923

In response to the GP Magazine report showing 90% of PCTs/CCGs are restricting procedures, the then Health Minister Simon Burns said:

“Last year we made it clear that it is unacceptable for the NHS to impose blanket bans for treatment on the basis of costs.  That is why we banned PCTs from putting caps on the number of people who could have certain operations.

“If local health bodies stop patients from having treatments on the basis of cost alone we will take action against them.”

Simon Burns statement 18^th June 2012

These new NHS figures provide evidence that people are facing difficulties in accessing routine treatments that were previously readily available, with some patients forced to consider private care where the NHS has entirely stopped the service.  Other independent voices have also expressed the same concerns for patients.

The RNIB found:

“Restrictions on access to cataract surgery by 57 per cent of PCTs in England are forcing thousands of people to live with serious and unnecessary sight loss according to new research carried out by the Royal National Institute of Blind People (RNIB).

“There is regional variation, for example, patients in North East England can have surgery as soon as the cataract affects their lives. In the South East some patients need to have a visual acuity as low as the third line down on an eye chart before they are able to access surgery.”

RNIB press release, 24 May 2012,

An investigation by GP Magazine found:

“GPs increasingly have to fight to obtain NHS treatment for their patients as managers raise the limits on access to care, a GP investigation has found.”

GP online, 19 November 2012,

This random rationing and accelerating postcode lottery is undermining a universal, comprehensive National Health Service.

Newly formed Clinical Commissioning Groups, taking control of primary care services from April 2013, will have full discretion to restrict and decommission treatments – resulting in the differences between areas growing wider.

Health Minister Earl Howe recently reiterated the Government’s belief that:

“GPs are the group of professionals who have the closest understanding of their patients and are able to take a measured and professional assessment of health needs in a particular geographic area […]. The rationing of services on the basis of cost alone is wrong. It compromises clinical values and patient care. […] By transferring commissioning powers to GPs we are empowering them to make these decisions and work with their local patients to ensure that they get the care that they need”.

Interview with GP Magazine, Thursday 22^nd November 2012

Minister can no longer deny what is happening and must take urgent action before thousands more patients are left in pain and discomfort.

In light of the new evidence uncovered, Labour calls on the Government to:

1. Honour commitments to end cost-based rationing by overruling PCTs imposing such restrictions and reversing any rationing decisions which leave patients in pain, restrict mobility, limit their ability to live independently or have a major psychological impact
2. Stop decisions on rationing being taken without proper public consultation with patients and honour their claims to ensure full patient involvement and “no decision about me – without me”.

Annexe A – Corresponding restrictions and clinical explanation