Commissioning Policy Review Macclesfield Town Hall 18 th March 2014 Feedback Report Page0
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 2013. 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 Macclesfield Town Hall where we had 13 members of public who attended who were able to give their views on a variety of policies. Page1
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? Yes It is very hard to have something, then withdraw it so it should be funded If yes, how many cycles should be funded? Up to 3 cycles 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? No Yes if the husband has children, this should bear no relevance on the female and her choices Yes depends on the level of distress that this may have on the female Page2
Should the NHS fund 0,1,2 or 3 cycles 3 cycles 2 cycles If can afford to pay for kids, then you can afford IVF 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? If you go to a private hospital and had implant go wrong, then you should go to the NHS if it becomes a health risk Consider it as there are always options to appeal decisions Need to go back to the original provider as they should bear some of the responsibility We don t know anything about the individual, their state of mind, this needs to be looked at If the implants were ruptured would this make a difference? Yes should remove on the basis of clinical grounds Page3
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? Removed but not replaced and only removed on clinical and not cosmetic grounds 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? Yes- if it affects a person ability to work No need to take other steps such as support socks first before surgery referral 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? Page4
Should the NHS fund this sort of cosmetic surgery? Yes for clinical reasons If the operation for the gastric band was through the NHS then we should pay for the Apronectomy as it should come as a package Yes as they are taking control of their own situation so should have access to this treatment For the person to get to this stage, this should / could have been prevented Yes if they are getting infections then it would have a wider health impact Feedback: Other Policies and General Comments General Comments: If anything has been taken out of the policies, these need to be made clear where they have moved to It would be interesting to see the clinician perspective on scenario s We need to see the information on financial implications of the policies and percentage of budget that this affects Concerns around adopting a whole Cheshire and Merseyside policy as CCG s are supposed to reflect local need so some of the priorities for these policies may be different in different areas, therefore by adopting a policy for the whole of Cheshire and Merseyside the element of choice is being taken away Need to ensure feedback is disseminated widely in terms of decisions made If we are going to look on a broader geographical basis then we need to consider the whole individual Has any regard been given to providers who may be providing across a larger footprint, but the policies may affect their service delivery differently need to look at this Concerned about the power of GP s and barriers to treatment, referrals and process. Are there any ways that these blocks can be taken away, as patients are not always given full information Need to look beyond the commissioning policies and to other sectors. For example, if another organisation is implementing something that could affect a patient outcome which will ultimately enable the CCG to reach a target, this could be part funded by the CCG At what point will the broader issues be looked at in terms of these policies, so that the person is seen in a holistic rather than condition specific way Quality of life is important and also needs to be looked at Consultants and GP s are such gatekeepers and need to know, as patients what we are entitled to and to have an informed choice The way that care is delivered appears to focus on only have 1 thing wrong with you which needs to change Page5
There is an argument that if some treatments are easier to access, it can relieve the pressure elsewhere in the system It is very important for the NHS to invest in education and prevention, to enable members of the population to lead happy and fulfilled lives GP s need to take the lead on whole centred and person centred care 7.1: Infertility: Are we compelled to accept NICE guidance? There needs to be a clear criteria for this area If there are criteria in place to sanction IVF treatment for smokers, the same approach needs to be taken with Alcohol 19.2: Penile Implants There needs to be a clear criteria in this area Oxford Scores How will the policy implement subjectivity for pain Will you be moving away from Oxford scores to a new criteria in order to better manage expectations? 4.1: Diabetes Continuous Glucose Monitoring Implementation of this could be quite cost effective Cataracts Quality of life is important and needs to be considered on an individual basis Breast Procedure There needs to be a serious policy nationally with NHS obligations There is a need to decide this approach nationally Trauma and Orthopedics Patients need to be treated as individuals and their quality of life. It should be about them and not about their age. Page6
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 2014. Further Information For further information about the Clinical Commissioning Group s please contact the following: Rebecca Patel Public Engagement Manager NHS Eastern CCG 01625 663864 07768 238 874 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: 0800 218 2333 and visit the website on: https://www.cheshiremerseysidecsu.nhs.uk/commissioning-policy-review.htm Page7