Despite the government’s recent announcement that the NHS can expect a year-on-year funding increase of 3.3% - supposedly being paid for in part by a Brexit windfall - NHS England have announced plans to cut, or severely restrict, 17 supposedly ineffective treatments.
The NHA have previously pointed out, both here and here, that the government’s claims are not to be taken at face-value. This is due to the fact that the money is not going to key areas of need within the NHS. We know that the cash increase will not be going towards doctor and nurse training, capital expenditure, public health initiatives, or social care. Yet these areas have a major impact upon the performance of the NHS and are in acute need of new funds. Once this is taken into account the real figure for the funding increase stands at around 3%.
At the same time, independent bodies, such as the Nuffield Trust, Kings Fund, the Institute for Fiscal Studies and the Office for Budget Responsibility all agree that the NHS needs a year-on-year spending increase of 4%. This would bring the UKs expenditure on health in line with similar sized economies in the G7 and EU.
In light of this, the recent announcement by Steve Powis, the medical director of NHS England, is somewhat less surprising if not less shocking. Mr Powis contends that cutting, or severely restricting procedures for carpel tunnel syndrome, Dupuytren’s contracture and trigger finger, would save the health service £200m a year. He has also stated that he believes more treatments could be cut, and that they are currently costing the taxpayer £2bn a year. This has all been justified by claiming that the procedures are themselves clinically ineffective; as the illnesses their designed to treat tend to go away by themselves.
This is not a development that should be taken lightly, and it is the responsibility of the media and our politicians to hold these proposals up to the cold light of scrutiny. However, we are currently seeing a lack of contestation over the veracity of claims that these procedures are ineffective. Especially on the part of the media.
This is even more worrying in light of the fact that organisations with direct clinical experience, such as the British Society for Surgery of the Hand dispute Powis’s claims, responding to the announcements they said:
“Those of us working in the NHS are committed to providing value for money. As hand specialists we are fully focused on delivering effective, evidence-based treatment for our patients. Carpal tunnel syndrome, Dupuytren’s contracture and trigger finger are common conditions which have a significant detrimental effect on quality of life. Timely treatment for these conditions is effective in relieving symptoms, preventing irreversible loss of function and keeping patients in employment.
“We have extensive data on the efficacy, success and cost effectiveness of these treatments, which are relatively low cost in terms of resources. For these procedures to be branded ‘unnecessary or risky’, ‘useless’ or ‘harmful’ is incorrect and is grossly misleading to patients and the public. Having said this we accept that there needs to be some rationing and we look forward to seeing the consultation paper and to working with NHS England and others to ensure the evidence available is fully understood.”
As with most major changes to the NHS we will have to await the findings of a consultation, in this case opening on the 4th of July, to see to what extent NHS England is able to go through with these plans.
In the meantime, the NHA will continue to widen the debate and contest the idea that the procedures - a full list of which you can see here - are clinically ineffective.