(1) Treatments subject to clinical eligibility thresholds and (2) Low priority treatments

Transcription

1 (1) Treatments subject to clinical eligibility thresholds and (2) Low priority treatments

2 VERSION CONTROL Version: 2.0 Ratified by: Governing Body Date ratified: 12 June 2013 Name of originator/author: Name of responsible committee: Public Health/Commissioning Dept Clinical Quality and Governance Date issued: June 2013 Review date: April 2016 VERSION HISTORY Date Version Comment / Update April Previous PCT policy June Version to Governing Body approved on 12 June 2013 Page 2 of 30

3 Contents 1. Policy Statement Introduction Policies Policy Implementation Plan Page 3 of 30

4 1. Policy Statement Funding of certain treatments by NHS Coventry and Rugby Clinical Commissioning Group are subject to thresholds or restrictions. This policy sets out: (1) Eligibility criteria for treatments subject to clinical eligibility thresholds (2) Treatments that are considered low priority and are not routinely funded. 2. Introduction 2.1. This policy addresses the issue of commissioning by NHS Coventry and Rugby Clinical Commissioning Group for procedures and treatments in the following categories: (1) Treatments subject to clinical eligibility thresholds (2) Treatments that are considered low priority and are not routinely funded It replaces and supersedes the Primary Care Trust s previous policy of July 2012 Rationale 2.3. The Clinical Commissioning Group receives a fixed budget with which to commission all the health care services required by its population. There are insufficient resources to fund all types of health care that might be requested for that population. It is therefore inevitable that the Clinical Commissioning Group has to make choices about which types of healthcare to commission. This priority setting takes place in the context of agreed commissioning principles. Health services are commissioned on the basis of evidence of clinical effectiveness, cost effectiveness, impact on health and affordability. Access to services should be governed by the principle of equal access for equal clinical need In developing this policy, the NHS Coventry and Rugby Clinical Commissioning Group has considered a number of factors, including experience with the predecessor policy, evidence of clinical effectiveness, information on current and historical activity, and resources and costs. It has also compared its proposals with similar policies adopted by other NHS commissioning organisations There is no absolute ban on any treatments. There is an established policy and mechanism for dealing with individual funding requests (IFR) and exceptions to policies, where exceptional individual clinical circumstances can be demonstrated. Scope 2.6. This policy applies to the following treatments, procedures and services: (Also see Table 1) Arthroscopy for diagnostic examination of knee joint Asymptomatic carotid artery disease (surgical treatment) Carpal Tunnel Syndrome Cataract Removal in adults Circumcision Continuous Positive Airway Pressure (CPAP) Dilatation and Curettage (D & C) for menorrhagia Dupuytren s Disease Facial Blushing and/or sweating - Endoscopic Thoracic Sympathectomy Page 4 of 30

5 Gallstone surgery (if not symptomatic) Ganglion Treatment Grommets/myringotomy Haemorrhoidectomy Hyperhidrosis (excess sweating) of the palms and axillae Surgical treatments, Iontophoresis and Botox Hysterectomy for menorrhagia Inguinal Hernia in adults asymptomatic Labiaplasty Penile Implants Prolapse (surgical management of female genital prolapse) Rhinoplasty / septorhinoplasty Tonsillectomy/Adenotonsillectomy for recurrent tonsillitis Trigger Finger release surgery Varicose Vein Surgery 2.7. Funding of drugs is not within the remit of this policy The NHS is required to provide funding and resources for medicines and treatments recommended by NICE Technologies Appraisal (TA) guidance, normally by three months from the date of publication of each TA. The other types of NICE guidance are not subject to a mandatory requirement regarding funding. NICE clinical guidelines are aspired to, and other types of guidance are noted, by the Clinical Commissioning Group This policy applies to all service providers in secondary care that carry out these treatments and procedures. Service providers must apply the criteria within this policy before carrying out the treatment Treatments undertaken in accordance with the eligibility criteria guidance specified in section 2 of this policy will be subject to case notes audit. In all cases, the fact that the patient meets the criteria specified in the guidance must be clearly documented in the notes Certain treatments may be subject to the need for prior approval from the Clinical Commissioning Group before the treatment can be carried out General practitioners should note the provisions of this policy before making a referral to secondary care for a low priority procedure. It is anticipated that GPs will not refer cases where it is clear that the eligibility criteria are not met. However, on occasions general practitioners may not be best placed to decide whether or not the policy criteria apply in a particular case and thus may refer to secondary care Although the policy does not currently apply to treatments that can be prescribed in primary care or minor surgical procedures that can be carried out entirely within a general practice, GPs may wish to base their decision to treat on the principles and criteria contained within this policy Table 1 broadly groups and summarises all the treatments covered by this policy. Page 5 of 30

6 TABLE 1 INDEX OF TREATMENTS Prior Approval reference Page reference 2.1 Hand & wrist procedures Carpal Tunnel Syndrome LPP/PA/001 8 Dupuytren s Disease LPP/PA/002 9 Ganglion Treatment LPP/PA/ Trigger Finger release surgery LPP/PA/ Other orthopaedic musculo-skeletal procedures excluding spinal and hand & wrist) Arthroscopy for diagnostic examination of knee joint N/A General surgical & urological procedures Asymptomatic carotid artery disease N/A 14 Circumcision LPP/PA/ Gallstone surgery (if not symptomatic) LPP/PA/ Haemorrhoidectomy N/A 15 Inguinal Hernia in adults LPP/PA/ Penile Implants N/A 16 Varicose Vein Surgery LPP/PA/ ENT procedures Grommets/myringotomy LPP/PA/ Rhinoplasty / septorhinoplasty LPP/PA/ Tonsillectomy/Adenotonsillectomy for recurrent tonsillitis LPP/PA/ Page 6 of 30

7 2.5 Gynaecological procedures Dilatation and Curettage for menorrhagia (D & C) N/A 18 Hysterectomy for menorrhagia LPP/PA/ Prolapse (surgical management of female genital prolapse) LPP/PA/ Labiaplasty N/A Ophthalmological procedures Cataract Removal in adults N/A Miscellaneous procedures and treatments Continuous positive airway pressure (CPAP) for adults with obstructive sleep apnoea/hypopnoea Facial Blushing and/or sweating Endoscopic Thoracic Sympathectomy Hyperhidrosis (excess sweating) of the palms and axillae Surgical treatments, Iontophoresis and Botox LPP/PA/014 N/A N/A Page 7 of 30

8 3. Policies 3.1 Hand and wrist procedures Carpal Tunnel Syndrome Prior approval required LPP/PA/001 (Threshold for surgical treatment shown in shaded area below) Management should be in accordance with British Society for Surgery of the Hand recommendations 1 : Severity of carpal tunnel syndrome (CTS): 1 Mild - nocturnal - position of hand - pregnancy - hypothyroidism Moderate - interference with activities of daily living - constant night waking reversible numbness and/or pain (perhaps by clenching and unclenching of fist or hand Severe weakness of thumb muscles Confirmation of the diagnosis of CTS with electro-physiological testing is usually reserved for equivocal diagnoses and are not required routinely. Situations where these tests may be indicated include: 1 atypical or bilateral symptoms and/or suggestive of neck involvement or double crush syndrome Page 8 of 30

9 Threshold : medico- British Society for Surgery of the Hand recommendations for Treatment 1 Mild / Moderate (Primary care treatment) Exclude pregnancy, hypothyroidism, and diabetes clinically and/or by investigation: Consider activity / work-place modification (if clear association apparent) and referral to hand therapy service Consider steroid injection proximal to wrist crease if trained injector available Moderate (Tertiary Treatment) Patients with moderate indications must have a trial of 3 months night splints before referral Patients with moderate indications with co-morbidities can be referred earlier: ie Elderly, diabetics, rheumatoid arthritics, patients with CTS and cervical spondylosis Severe (Tertiary treatment) Indication: severe signs/ symptoms Open / endoscopic carpal tunnel release Dupuytren s Disease Prior approval required LPP/PA/002 Ref: 1. BSSH (2011) BSSH Evidence for Surgical Treatment (BEST): Carpal Tunnel Syndrome (CTS) [Online] Available from: [Retrieved 25 January 2011 (Threshold for surgical treatment shown in shaded area below) Management should be in accordance with British Society for Surgery of the Hand recommendations 1 : Page 9 of 30

10 Threshold : Classification: 1 Mild No functional problems No contracture Mild metacarpo-phalangeal joint contracture only (<30 0 ) Moderate or moderate metacarpo-phalangeal joint contracture ( Moderate proximal inter-phalangeal joint contracture (<30 0 ). Severe Severe contracture of both metacarpo-phalangeal (>60 0 ) joint and proximal interphalangeal joint (>30 0 ). Treatment recommendations: 1 Mild Moderate Refer for surgery Severe - limited fasciectomy / dermofasciectomy Page 10 of 30

11 Ref: 1. BSSH (2011) BSSH Evidence for Surgical Treatment (BEST): Dupuytren s Disease [Online] Available from: Ganglion Treatment Prior approval required LPP/PA/03 [Retrieved 25 January 2011] (Threshold for surgical treatment shown in shaded area below) Management of wrist ganglion should be in accordance with British Society for Surgery of the Hand recommendations 1 : Classification: 1 Mild Moderate Cancer- Severe Treatment recommendations: 1 Mild Moderate - Aspiration for cancer reassurance Ref: 1. BSSH (2011) BSSH Evidence for Surgical Treatment (BEST): Wrist Ganglion [Online] Available from: [Retrieved 25 January 2011] Page 11 of 30

12 Threshold : Trigger Finger release surgery (adults) Prior approval required LPP/PA/004 (Threshold for surgical treatment shown in shaded area below) Management should be in accordance with British Society for Surgery of the Hand recommendations 1 : Classification: 1 Mild ( pre-triggering ) Moderate A - Difficulty actively extending finger B - Need for passive finger extension Loss of complete active flexion Severe Fixed contracture Treatment recommendations: 1 Mild Analgesia Moderate Steroid injection to flexor sheath Severe (as defined above) or failed non-operative treatment Surgical trigger release Ref: 1. BSSH (2011) BSSH Evidence for Surgical Treatment (BEST): Trigger Finger (Thumb) [Online] Available from: [Retrieved 25 January 2011] Page 12 of 30

13 Threshold : 2.2 Other orthopaedic musculo-skeletal procedures (excluding spinal and hand & wrist) Arthroscopy for diagnostic examination of knee joint Restricted (threshold) Arthroscopy of the knee can be undertaken where a competent clinical examination (or MRI scan if there is diagnostic uncertainty or red flag symptoms/signs/conditions) has demonstrated clear evidence of an internal joint derangement (meniscal tear, ligament rupture or loose body) and where conservative treatment has failed or where it is clear that conservative treatment will not be effective. Knee arthroscopy can therefore be carried out for: Removal of loose body Meniscal surgery (repair or resection) Ligament reconstruction/repair (including lateral relapse) Synovectomy Treatment of articular defects e.g. micro-fracture Knee arthroscopy should not be carried out for any of the following indications: Investigation of knee pain Treatment of osteoarthritis (except in line with NICE guideline (CG59) 1 ) A proportion of knee arthroscopies may not lead to the anticipated therapeutic intervention, and therefore will be coded as diagnostic arthroscopies. Surgeons are asked to ensure that coding of Page 13 of 30

14 the arthroscopy is undertaken after the procedure has taken place. Ref: 1. The National Collaborating Centre for Chronic Conditions (Royal College of Physicians) / National Institute for Health and Clinical Excellence (NICE) (2008) Osteoarthritis - National clinical guideline for care and management in adults. [Available online from: Retrieved 26 January 2011] 2.3 General surgical & urological procedures Asymptomatic carotid artery disease Restricted Carotid surgery for patients with no recent symptoms (<12weeks) is restricted to patients with a life expectancy >5 years; patients with evidence of embolic phenomena on retinoscopy; and patients prior to major surgery who have a severe unilateral stenosis >70%. NB. There is an absence of evidence from randomized trials that patients aged greater than 75 benefit from surgery from asymptomatic lesions. Ref: ACST. Lancet May 8:363(9420) Circumcision Prior approval required Only funded if there is a clinical reason for circumcision to be undertaken. LPP/PA/005 Clinical reason should be documented and may include:1. Paraphimosis 2. Pathological phimosis eg due to scarring 3. Recurrent episodes of balanitis in children 4. Suspected penile malignancy Page 14 of 30

15 Threshold : Gallstone Surgery (if not symptomatic) Prior approval required In general it is recognised that most patients with asymptomatic calculi are best managed by continued observation and not cholecystectomy. LPP/PA/006 Surgery not supported unless significant symptoms (such as episodes of biliary colic or cholecystitis in a person with ultrasound-confirmed diagnosis of gallstones) are present. Haemorrhoidectomy Restricted (threshold) First and second degree haemorrhoids are usually treated with some form of non-surgical ablative/fixative intervention, third degree ones are treated with rubber band ligation or haemorrhoidectomy, and fourth degree with haemorrhoidectomy. Inguinal Hernia in adults Prior approval required Haemorrhoidectomy should be considered only in case of: Recurrent haemorrhoids Persistent bleeding Failed conservative treatment The elective surgical treatment of asymptomatic or mildly symptomatic inguinal hernias in adults will not be funded. LPP/PA/007 Conservative management of unilateral inguinal hernia might be considered a reasonable strategy in people who have only mild symptoms, in whom the risk of hernia complications is low. There is evidence 1 that it is safe to manage asymptomatic inguinal hernias non-operatively, i.e. with watchful waiting. Page 15 of 30

16 Threshold : Patients should only be referred if they fulfil any of the following criteria: There is an inguino-scrotal hernia Increase in size month to month Pain or discomfort significantly interfering with activities of daily living, which may include the ability to work History of incarceration or real difficulty reducing the hernia Ref: 1. Fitzgibbons RJ Jr, Giobbie-Hurder A, Gibbs JO, Dunlop DD, Reda DJ, McCarthy M Jr, Neumayer LA, Barkun JST, Hoehn JL, Murphy JT, Sarosi GA Jr, Syme WC, Thompson JS, Wang J, Jonasson O. (2006) Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial. JAMA, 295 (3): [Available online from: Retrieved 26 January 2011] The above applies to inguinal hernias. Patients with femoral hernias should be referred for consultation Penile Implants Excluded Penile implants are not funded on the grounds of insufficient evidence of cost-effectiveness for them to be provided routinely to all patients Varicose Vein Surgery Prior approval required Refer to the locally agreed protocol for referral of varicose veins and the five classifications. LPP/PA/008 Class 1 - represents thread veins or reticular veins with cosmetic symptoms. Not funded. Class 2 - represents varicose veins with no complications. Not funded Page 16 of 30

17 Threshold : Class 3 - represents varicose veins with skin changes at the ankle with the additional possibility of further complications (bleeding, superficial thrombophlebitis, oedema). Funded. Class 4 - represents skin changes ascribed to venous disease pigmentation, venous eczema, lipodermatosclerosis. Funded. Class 5 and 6 - represents severe skin changes and/or active ulceration. Late stage venous disease. Refer for vascular assessment. 2.4 ENT procedures Grommets/ myringotomy - indications for surgery in children Prior approval required LPP/PA/009 Surgical treatment will only be supported in accordance with the care pathway for children with suspected otitis media with effusion in NICE Clinical Guideline 60 (February 2008) on Surgical Management of Otitis media with effusion in Children (available from: This includes a period of active observation for three months (to be completed before the child is placed on a waiting list for a surgical intervention). Rhinoplasty / Septorhinoplasty Prior approval required LPP/PA/010 Prior approval required These procedures should not be carried out for cosmetic reasons. These procedures will only be funded for the following conditions (with indications clearly documented for audit purposes): Correction of nasal deformity causing significant nasal blockage Correction of significant nasal deformity arising from documented history of direct nasal trauma Correction of nasal deformity associated with specific recognised facial congenital disorders. Tonsillectomy will be supported and funded for children or adults where patients meet all the following Page 17 of 30

18 Tonsillectomy/ LPP/PA/011 criteria: Adenontonsillectomy for recurrent tonsillitis Sore throats are due to tonsillitis They have had five or more episodes of tonsillitis per year (This should be stipulated in GP referral letter. If not stated then the acute trusts should return the referral and not instigate treatment as it will not be funded) Symptoms for at least a year The episodes of tonsillitis are disabling and prevent normal functioning The CCG will also consider patients with the following symptoms even if the patient does not meet all of the above criteria: A convincing history of obstructive sleep apnoea associated with tonsillar enlargement (which may be supported by a sleep study or accepted method of diagnosis) More than one episode of peri-tonsillar abscess (quinsy) Patients with tonsillar enlargement causing acute upper airway obstruction Suspected tonsillar malignancy is an unequivocal indication for tonsillectomy, and not subject to the criteria above. 2.5 Gynaecological procedures Dilatation and Curettage for menorrhagia (D&C) Restricted D & C not funded as a therapeutic intervention for menorrhagia, irregular periods, or endometrial hyperplasia (thickening lining of uterus). D & C alone should not be used as a diagnostic tool but may be undertaken as an aid to diagnosis of the causes of abnormal uterine bleeding. Hysterectomy for Prior approval required Hysterectomy will not be commissioned as a first line treatment for women diagnosed with Page 18 of 30

19 Threshold : menorrhagia menorrhagia and/or dysmenorrhoea. LPP/PA/012 Hysterectomy will be supported for menorrhagia and/or dysmenorrhoea only when other treatment options have failed, or are contraindicated. Prolapse (Surgical management of female genital prolapse) Prior approval required LPP/PA/013 Surgical treatment is not routinely funded for asymptomatic or mild pelvic organ prolapse. Self help information such as weight loss and avoidance of constipation should be provided together with physiotherapy for pelvic floor muscle training or trial of ring pessary where symptoms are mild. Referral for specialist assessment is indicated for: Prolapse combined with urethral sphincter incompetence or faecal incontinence Moderate to severe symptoms Failure of pessary Labiaplasty Excluded Labiaplasty of the labia minora for cosmetic or functional reasons is not funded This policy does not relate to reversal of female mutilation which is routinely funded. Page 19 of 30

20 2.6 Ophthalmological procedures Cataract Removal in adults Restricted (threshold) Cataract surgery will be commissioned for patients who, after correction (e.g. with glasses), have 6/12 or worse in their cataract affected eye Referrals for cataract surgery should not be based simply on the presence of a cataract Cataract surgery will not be commissioned solely for the purpose of correcting longstanding pre-existing myopia and hypermetropia In certain situations cataract surgery will be commissioned for patients with a visual acuity better than 6/12, for example, where there are issues associated with significant glare disability or significant multiple vision. Cataract surgery will be supported where there is binocular disparity/imbalance (anisometropia) Treatment will also be commissioned for the second eye where it is not 6/12 or worse but not treating would have a significant effect on the patient s vision Cataract surgery will also be funded in situations where it is indicated for screening or management of other ocular co-morbidities e.g. for control of glaucoma, or for adequate view of diabetic retinopathy 2.7 Miscellaneous procedures and treatments Continuous positive airway pressure (CPAP) for adults with obstructive sleep apnoea/hypopnoea Prior approval required LPP/PA/014 Treatment of OSAHS with CPAP should be in accordance with NICE technology appraisal guidance (TA 139, March 2008). 1 This recommends CPAP as a treatment option for adults with moderate or severe symptomatic sleep apnoea (as defined in the guidance). It recommends CPAP as a treatment option for mild cases only for: Page 20 of 30

21 syndrome (OSAHS). patients who have symptoms that affect their quality of life and ability to go about their daily activities, AND in whom lifestyle advice and any other relevant treatment options have been unsuccessful or are considered inappropriate. In cases where prior approval is sought for CPAP in patients with mild OSAHS, the Clinical Commissioning Group would expect that considerable efforts have been made to address lifestyle issues before this can be deemed unsuccessful or inappropriate. If the patient is a smoker, referral must be made to Stop Smoking services, and it must be established (using carbon monoxide [CO] validation) that the patient has quit smoking before CPAP is offered. In addition, the patient should be advised to lose weight (if they are overweight or obese) and to cut down alcohol consumption (if they take alcohol), with referral to appropriate services if indicated. If these lifestyle factors are relevant, approval for CPAP will be considered only if a substantial effort has been made by the patient (with appropriate support if indicated) to address these over a period of at least three months. Therefore, applications for prior approval for CPAP for patients with mild OSAHS in line with NICE guidance, must state the patient s status with respect to smoking, BMI and alcohol intake, and specify the steps that have been taken to manage these, before lifestyle advice can be deemed unsuccessful or inappropriate. Ref: 1. National Institute for Health and Clinical Excellence (NICE) (2008) Continuous positive airway pressure for the treatment of obstructive sleep apnoea/hypopnoea syndrome Page 21 of 30

22 Facial blushing and/or sweating - Endoscopic Thoracic Sympathectomy Excluded Facial blushing is often a result of social phobia and is encouraged by an over-active sympathetic nervous system. There is limited evidence suggesting Endoscopic Thoracic Sympathectomy can control the occurrence of facial blushing and sweating, however, the patient may experience adverse side effects. Treatment not funded Hyperhidrosis (excess sweating) of the palms or axillae - Botulinum Toxin Therapy (Botox), Iontophoresis and surgical intervention Excluded Botulinum Toxin Therapy, Iontophoresis and surgical interventions for the treatment of Hyperhidrosis are not funded on the grounds of insufficient evidence of cost-effectiveness for them to be provided routinely to all patients Page 22 of 30

23 3. Scheme of Delegation This policy will be overseen by NHS Coventry and Rugby Clinical Commissioning Group Governing Body 4. Corporate Procedure The NHS Coventry and Rugby Clinical Commissioning Group support the revisions and renewal of the policy 5. Development and Consultation process The following individuals/groups have been involved in the development of this policy, or are key stakeholders: Name of Individual/Group Clinical Commissioning Group Officers Acute Hospital Trusts Representing Primary Care Secondary Care Page 23 of 30

24 Policy Implementation Plan Accountable officer : Policy author: Responsible person Issues identified/action to be taken Time-Scale Issues identified/action to be taken Co-ordination of implementation How will the implementation plan be co-ordinated and by whom? Clear co-ordination is essential to monitor and sustain progress against the implementation plan and resolve any further issues that may arise. The revised policy will be introduced into the contract with the acute trusts and other providers. The relevant providers and clinicians will be informed of the inclusion of the policy in the contract. Immediate Engaging staff Who is affected directly or indirectly by the policy? Are the most influential staff involved in the implementation? How will the policy be communicated to staff? Policy affects care of patients requiring the treatments listed in the policy. The policy will be implemented by relevant clinicians who will be advised of policy by trust management. Immediate Engaging staff and developing strong working relationships will provide a solid foundation for changes to be made. No major implications for Clinical Commissioning Group staff Page 24 of 30

25 Involving service users and carers Is there a need to provide information to service users and carers regarding this policy? Are there service users, carers, representatives or local organisations who could contribute to the implementation? Service users and carers will be advised by relevant clinicians when necessary. Immediate Involving service users and carers will ensure that any actions taken are in the best interest of services users and carers and that they are better informed about their care. Communicating What are the key messages to communicate to the different stakeholders? How and to who will these messages be communicated? Effective communication will ensure that all those affected by the policy are kept informed thus smoothing the way for any changes. Key message is that the NHS South Warwickshire Clinical Commissioning Group consider certain procedures as low priority and certain criteria will apply to each individual treatment This message will be communicated to acute trusts and other providers as part of contract process. Immediate Training What are the training needs related to this policy? Are people available with the skills to deliver the N/A Page 25 of 30 N/A

26 training? All stakeholders need time to reflect on what the policy means to their current practice and key groups may need specific training to be able to deliver the policy. Resources Have the financial impacts of any changes been established? Is it possible to set up processes to re-invest any savings? Are other resources required to enable the implementation of the policy eg increased staffing, new documentation? Identification of resource impacts is essential at the start of the process to ensure action can be taken to address issues which may arise at a later stage Yes No No In year Securing and sustaining change Have the likely barriers to change and realistic ways to overcome them been identified? Who needs to change and how do you plan to approach them? Have arrangements been made with service managers to enable staff to attend briefing and training sessions? Are arrangements in place to ensure the induction of new staff reflects the policy? N/A N/A Page 26 of 30

27 Initial barriers to implementation need to be addressed as well as those that may affect the on-going success of the policy Evaluating What are the main changes in practice that should be seen from the policy? How might these changes be evaluated? Patients will need to be assessed against policy prior to referral/treatment How will lessons learnt from the implementation of this policy be fed back into the organisation? Level of activity will be monitored. N/A Evaluating and demonstrating the benefits of new policy is essential to promote the achievements of those involved and justifying changes that have been made. Impact will be assessed and considered for implementation of future policies. Page 27 of 30

28 Equality Impact Assessment CCG NHS Coventry and Rugby Comm Supp Arden Commissioning Support Name of lead person Clive Campton IFR Lead Piece of work being assessed Commissioning Policy: Treatments subject to clinical eligibility thresholds, and low priority treatments Aims of this piece of work To clarify which treatments fall under this policy and why they are restricted Date of EIA May 2013 Other partners/stakeholders involved Helen Bunter Equality & Diversity Specialist Who will be affected by this piece of work? All NHS Coventry and Rugby CCG responsible patients Single Equality Scheme Strand Gender Baseline data and research on the population that this piece of work will affect. What is available? Eg population data, service user data. What does it show? Are there any gaps? Use both quantitative data and qualitative data where possible. Include consultation with service users wherever possible Women are twice as likely as men to suffer from Carpal Tunnel Syndrome (ref :Australian and New Zealand Journal of Surgery Mar;68(3):190-3) Dupuytren s disease is ten times more common in men than women (ref: American Academy of Orthopedic Surgeons) Is there likely to be a differential impact? Yes, no, unknown Yes Page 28 of 30

29 Race Disability Trigger finder is more common in women than men (Ref: Bonnici and Spencer 2005) Penile circumcision only applies to males Women are two to three times more likely to have gallstones than men. Pregnant women are at particular risk (Ref: Novacek 2006) Women are more likely to have varicose veins than men (Ref: NHS Choices) D&C, prolapse, labiaplasty, and hysterectomy only apply to females Dupuytren s disease is more common in White ethnic groups (ref: American Academy of Orthopedic Surgeons) Cataracts are associated with diabetes which is higher in Asian and Black populations People with bilateral hearing impairment are not allowed two BAHAs Cataracts lead to visual impairment Yes Yes Religion/ belief Muslims are more likely to ask for non medical circumcision than any other group Yes Sexual orientation No information available to indicate that sexual orientation is a factor in any of these procedures Unknown Single Equality Scheme Strand Age Social deprivation Baseline data and research on the population that this piece of work will affect. What is available? Eg population data, service user data. What does it show? Are there any gaps? Use both quantitative data and qualitative data where possible. Include consultation with service users wherever possible People over 55 are more likely to suffer from Carpal Tunnel Syndrome (ref :Australian and New Zealand Journal of Surgery Mar;68(3):190-3) Dupuytren s disease is more common in older people (ref: American Academy of Orthopedic Surgeons) Varicose veins are more likely to occur in older patients (Ref: NHS Choices) Cataracts are more common with age Manual workers are more likely to suffer from Carpal Tunnel Syndrome (ref :Australian and New Zealand Journal of Surgery Mar;68(3):190-3) Page 29 of 30 Is there likely to be a differential impact? Yes, no, unknown Yes Yes

30 Carers No Human rights Will this piece of work adversely impact on anyone s human rights? No Equality Impact Assessment Action Plan Strand Issue Action required How will you measure the outcome/impact Timescale Lead Page 30 of 30