Commissioning Policy Review Wilmslow

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1 Commissioning Policy Review Wilmslow Feedback Report Page0

2 Overview Clinical Commissioning Groups have a duty to spend public money wisely. As there is only a set amount of money available to spend, we have to make difficult decisions about which treatments are routinely provided. Most of the services or treatments we commission are provided for our whole population. However, some are only clinically effective in very specific situations or for a very narrow group of patients. The Commissioning Policy Review The NHS never stands still. Advances in science mean it is constantly evolving to keep pace with the invention of new drugs, new treatments and new technology. As new treatments and services become available, demand goes up and we will have to make tough decisions on how to spend our limited budget for the benefit of our whole population. We will need to do this in a number of ways: we may need to prioritise certain treatments and procedures we may have to set thresholds (or a defined set of criteria) that a patient must fit before they can be referred for particular treatments or procedures. This is because some treatments only work in very specific clinical situations or for a very narrow group of patients there are circumstances when we can only fund certain procedures or treatments if there are clinical grounds for doing so We have only existed as a statutory NHS body since 1st April As a result, some of our commissioning policies need reviewing and updating - which will include financial decision making. We require the feedback on our draft Commissioning Policy that is currently being reviewed by Cheshire and Merseyside Commissioning Support Unit on behalf of the CCG. This policy incorporates procedures of lower clinical priority and Infertility. Members of the public were invited to come along to a public meeting held at Wilmslow Library, we had 3 members of public who attended who were able to give their views on a variety of policies. Page1

3 Feedback: Patient Scenario s A number of scenario s were presented to participants and their thoughts are illustrated below. Infertility Jasmine is 35 years old who has been trying with her husband to get pregnant for the last two years but without success. They do not have any children. Following investigations she has been referred for fertility treatment. 1) Should the NHS pay for her IVF cycle? 2) If yes, how many cycles should be funded? Should the NHS Pay for her IVF Cycle? 2 years is not very long to try for a baby Yes we should fund her IVF cycle If yes, how many cycles should be funded? Based on cost should only be 2 cycles If wanted children can afford to pay for 3 rd cycle or adoption Infertility Joanne is 30 years old and recently met her partner who already has children. Joanne has been investigated and the investigations have revealed that she will be unable to conceive because she has a problem with her fallopian tubes. 1) Should the NHS pay for her IVF treatment cycles? 2) Should the NHS Fund 0,1,2 or 3 cycles. Should the NHS pay for her IVF treatment cycles? I feel sorry for Joanne, and it seems that it can be unfair if you know how to use the system Page2

4 Has an impact on the individual No need further information of history, because if she did not know that she is infertile then perhaps she should be offered a cycle If she can afford to pay privately, that should be her option Should the NHS fund 0,1,2 or 3 cycles Dependent on history if she was aware of being infertile then 0 cycles, if unknown then should fund 1 cycle. Breast Procedure Lucy is 30 years old and had a cosmetic breast enlargement 9 years ago that she paid for herself. She has noticed they have become mis-shapen and a little tender. Investigation has shown a capsule around the implants. It is possible to remove the capsule and implants and replace new ones as the old ones are coming towards the end of their life. The patient cannot afford to pay for any of this now. 1) Should the NHS fund any part of this operation, if so what part? 2) If the implants were ruptured would this make a difference? 3) Should the NHS remove the implants but not replace them, as they were inserted for cosmetic reasons in the first place, even though the cosmetic result may be poor? Should the NHS fund any part of this operation and if so what part? Should fund the removal of capsule If the implants were ruptured would this make a difference? Should take out the ruptured implant. Should the NHS remove the implants but not replace them, as they were inserted for cosmetic reasons in the first place, even though the cosmetic result may be poor? Should take out the implants but not replace them There could be an underlying mental health issue here in relation to poor selfesteem which may need to be tackled. Page3

5 Varicose Veins John is a barber and is concerned about a Varicose Vein that has appeared on his right leg. It sometimes hurts when he is standing for a long time. There is also some swelling at the end of the day and he can t wear any support socks because it is too hot in the salon. He is very concerned about its appearance. 1) Should the NHS fund varicose vein treatment for John? 1) Should the NHS fund varicose vein treatment for John? No not just on appearance alone. There are other things that can be tried first, such as involvement of a physiotherapist. Apronectomy Janet is 45 years old and has lost 7 stone after a gastric band. She is left with a large flap of skin on her abdomen which hangs down. In the summer the skin gets very sweaty and can get sore and inflames. Clothes are a problem and she is distressed about her appearance and wont undress in front of her partner. 1) Should the NHS fund this sort of cosmetic surgery? Should the NHS fund this sort of cosmetic surgery? No on cosmetic reasons, however there is a clinical risk Mental health could be affecting individual, so will need to look at funding this operation to prevent longer term damage. Page4

6 Feedback: Other Policies and General Comments General Comments: If the changes are part of NICE guidance, all patients should be able to ask for it, otherwise we ruin the risk of a postcode lottery Emphasis for commissioning needs to be on keeping people healthy Need to encourage patient to self-care It is important that Physiotherapists are attached to GP practices to ease the waiting time for patients and taking up of appointments Infertility Should be an age limit up to the age of 35 as a maximum Theoretically, if infertility treatment are becoming more successful then we wont need to buy as many cycles for women Penile Implant Would penile implant have an age range Decisions are based a lot on state of mental health and GP Oxford Scores Hips and Knee replacements Needs to be at the right time, if we leave it too long other problems come in and can be weak on one side Need a lot of patient education and a good GP Outcome is poor if left too long There is a need to educate the public about Oxford Scores and self-care 17.1, 17.2: Respiratory Services Interrupted breathing could cause serious issues Decisions are dependent upon local GP and surgeon If causes discomfort then something needs to be done Need to agree the level of criteria Need to take different steps before get to surgery stage, and this needs to be made clear in the policy. 2.1: Complementary Therapies (Including Homeopathy) If there is some proven scientific evidence, then we need to look at funding as this is part of the Physiotherapist s range of tools to help patients Chiropractors can be very good, but there are mixed feelings about their services 13.5: Opthalmology Can do the cataracts too soon, where you don t notice the benefit or leave them for too long Page5

7 Received a good experience at Macclesfield hospital for cataracts and received a good service from opticians Suggestion that opticians should be able to refer to cataract surgery, as they are experts in eyes but current system does not allow this, but could be better for the patient Impressed by evening clinic provision at Macclesfield Hospital Next Steps All of the comments, thoughts, ideas and opinions that have been raised will be fed into the Commissioning Policy Review consultation, and the outcome of your involvement will be fed back to you after the 7 th April Further Information For further information about the Clinical Commissioning Group s please contact the following: Rebecca Patel Public Engagement Manager NHS Eastern CCG rebeccapatel@nhs.net For further information about the Commissioning Policy Review, please contact Cheshire and Merseyside CSU on the following details: Julia Curtis Project Manager Cheshire and Merseyside Commussioning Support Unit 1829 Building Countess of CHSTER Health Park Liverpool Road Chester CH2 1HJ You can also contact the Customer Solutions Centre on: and visit the website on: Page6