Spending NHS money wisely 2 NOTE: Because this document is about the future of local NHS services, it talks about a lot of medical conditions. So, when a tricky word is used it will be in bold blue text so that you can look it up in the Word List at the back if you need to. What do you think about our ideas? This document tells you some of the changes we are thinking about making so we can save the NHS money we need to in Barking and Dagenham, Havering and Redbridge. We want to know what you think and if there is anything else you want us to think about. We d like to hear from as many local people as possible, so please tell your friends and family about this, and ask them to let us know what they think too. Please tell us what you think by 5pm on 15 November 2017. What s happening? We need to be careful with the money we have locally to pay for NHS services and treatments. We do not have enough money to carry on providing things in the way we do now. We need to save 55 million from our budget in the 2017/18 financial year. To do this, we need to lower our spending in some areas. So we are thinking about what services and medicines to no longer fund, and also whether to limit who can access some services. Nothing has been decided. We want to know what you think we should do.
The local NHS needs to save money We re already trying to save money by: Making sure patients can be seen in a number of health setting and not just a hospital Making better use of technology Looking at our contracts with hospitals and other health providers to make sure they show improvements in people health as well as value for money Making sure we are not paying for building space we don t need and fitting more staff in offices where we can Spending NHS money wisely Still Fund: Sterilisation Breast reduction Facial mole & cyst removal Spending NHS money wisely From March to May this year we ran an eight-week consultation called Spending NHS money wisely which set out ideas for making 5.2m if savings through no longer finding or restricting a number of medications and procedures. We had over 660 responses, and after thinking carefully we agreed to: Stop finding over the counter painkillers, muscle rubs, vitamins, gluten-free foods Stop funding certain surgical procedures such as face lifts, varicose vein surgery and brow lift surgery Fund one in-vitro fertilisation (IVF) embryo transfer, instead of three. However, our GP directors didn t agree to stop finding sterilisation and procedures like breast reductions and removing moles and cysts from people s faces after listening to people s concerns about the impact some of the proposals would have. The restrictions agreed should result in around 3 million of savings a year.
What we think we should do We have found some further areas of spending where we think making changes could save up to 4 million each year: NHS prescribing Every year GPs give out a lot of prescriptions for medicines, some of which can be bought in supermarkets or pharmacies, easily and cheaply, without the need for a prescription. Prescribing these medicines is often quite expensive for the NHS, as it includes the cost of GP appointment times and pharmacist fees. For some of these medicines there is little proof to show they improve people s health. We are suggesting that GPs no longer give prescriptions for some medications. We have now looked at other medicines GPs give prescriptions for. We have listed the medicines we don t think GPs should give NHS prescriptions for in the table on the following pages.
Medicine Why we want to stop funding Example of price Cost to us Anti-malarial medicine We think travellers should include the cost for these medicines in their holiday budget, just like they have to include the cost of flights, accommodation and insurance. For a 2-week trip: Proguanil and Chloroquine, 19.39 (Boots) Doxycycline, 28.60 (Boots) 5,041 189 prescriptions Medicines can be privately prescribed by a GP or travel clinic, who can advise how to use them. Threadworm medicine Can be bought from a pharmacy, who can advise how to use it. Boots 4 tablets to treat 4 people, 7.50 Lloyds 4 tablets to treat 4 people, 7.95 Lloyds Banana 30ml Family Pack, 9.79 3,022 2.125 prescriptions Sleeping tablets Treatments for mild/short-term sleeping problems can be bought over the counter at low cost. We intend to continue to prescribe sleeping tablets for severe sleeping problems. Tesco Herbal Sleep Aid, 30 tablets, 2.50 Boots Sleepeaze Herbal Tablets, 30 tablets, 3.29 Nytol Herbal Tablets Night Time Sleep Aid, 30 tablets, 3.69 (Boots) 31,622 11782 prescriptions
Hayfever medicine Widely available at low cost from supermarkets, pharmacies and other retailers. Tesco 14 tablets, 1.80 Optrex Eye Drops 3.99 (Boots) Boots Hayfever Adults Nasal Spray, 4.59 227,518 148,228 prescriptions Travel sickness medicine Mild travel sickness can usually be improved using self-care techniques, e.g. fixing your eyes on the horizon getting some fresh air. More severe travel sickness can be treated with medicine, which can be bought from a pharmacy, who can advise how to use it. Kwells Kids 12 tablets, 2.68, (Boots) Boots Travel Calm 12 Tablets, 2.79 Lloyds Travel Sickness 10 Tablets, 1.72 45,650 12,426 prescriptions Vitamin D supplements (for maintenance only) Vitamin D is essential for strong bones and should be obtained from sunlight and through food rather than pills. We intend to continue to prescribe vitamin D for deficiency. If people want to take supplements for maintenance, they are widely available at low cost.. ASDA Bone Health High Strength Vitamin D, 60 tablets, 2.00 Boots Vitamin D, 90 tablets, 2.29 Tesco Vitamin D 90 tablets, 3.00 299,875 49,338 prescriptions Skin rash creams Widely available at low cost. Note: If your rash lasts more than a few days you should visit a pharmacist or GP for advice. Boots Pharmaceuticals Calamine & Glycerin Cream, 35g, 1.60 36,661 10,661 prescriptions
Bath oils, shower gels and shampoo Widely available at low cost from supermarkets, pharmacies and other retailers. For people with dry or scaly skin and scalp conditions we intend to continue to prescribe creams to treat these. Oilatum Junior Bath Additive, 150ml, 3.50 (Tesco) E45 Wash Cream for Dry and Itchy Skin, 250ml, 5.39 (Boots) E45 Dry Scalp Shampoo, 200ml, 6.30 (Boots) 365,658 61,783 prescriptions Probiotics No evidence to support claims of the health benefits of probiotics (products containing live bacteria and yeasts). Widely available at low cost from supermarkets, pharmacies and other retailers. ASDA Vitamin Boosting Strawberry Yogurts Drink, 8x100g, 1.50 Actimel Vanilla Yoghurt Drink, 8x100g, 2.90 (Tesco) Acti Mint Probiotic Supplement, 60 tablets, 6.25, (Lloyds) 19,798 449 prescriptions Sunscreens Widely available at low cost from supermarkets, pharmacies and other retailers. Note: Sunscreens would continue to be prescribed for people undergoing treatment for cancer and/or specialist skin conditions. Boots Essentials SPF15 Lotion, 400ml, 2.49 Tesco Soleil SPF15 Lotion, 200ml, 3.50 Nivea Moisturising SPF30 Lotion, 200ml, 6.00 (Boots) 15,016 1,252 prescriptions This should save us around 575,280 per year.
Stopping funding certain procedures We are proposing that we no longer fund the following procedures, because they are not essential, do not always have a sure health benefit and cost the NHS a lot. These are: Ear wax removal Some injections for lower back pain Osteopathy Ear wax removal We are thinking about whether we should continue to pay for people to have earwax removed by a suction machine. This is the removal of too much wax from inside the ear. Wax is produced inside your ears to keep them clean and free of germs. Sometimes too much can build up and block the ears, causing hearing difficulties. Note: If this were to go ahead we think some people should still receive NHSfunded ear wax removal by suction, like those who have had ear surgery. All people would still be able to have NHS-funded ear syringing to remove ear wax. We believe ear wax removal procedures are costing us 403,259 a year. 7
Injections for back pain We are thinking whether we should continue to fund some injections for back pain. These injections are intended to temporarily relieve pain, tingling and numbness. As recommended by pain management experts we think we should no longer fund some injections for back pain. This is because there is little proof that these injections work. These are: Spinal disc injections Facet joint injections Epidural injections for walking difficulties or pain. If this change were to go ahead, GPs would still be able to refer patients to musculoskeletal physiotherapist for treatment, and if needed, to the specialist pain management clinics at local hospitals. We believe injections for lower back pain are costing us 1.28 million a year. Osteopathy We are considering if the local NHS should continue to fund osteopathy. Osteopathy is a way of detecting, treating and preventing health problems such as joint pain, by moving, stretching and massaging a person's muscles and joints. It does not use medicines or surgery. Osteopathy is a complementary or alternative medicine and although osteopaths may use some medical techniques, its use is not always based on scientific evidence. If this change were to go ahead, GPs would still be able to refer patients for specialist treatment, for example to see a physiotherapist or attend a pain management clinic. Note: Osteopathy is not widely available as an NHS funded treatment and Redbridge is the only CCG in London that currently funds osteopathy. We believe that osteopathy in Redbridge alone, costs us 444,000 a year. 8
Changing the eligibility criteria for some procedures We are suggesting that we change the eligibility criteria for: Cataract surgery Podiatry This could mean that some people would not be able to get these procedures paid for unless their doctor was able to prove they met the criteria. Cataract surgery We are thinking about tightening the eligibility criteria for cataract surgery Sometimes surgery is needed to remove cataracts. However, you don t need to have surgery if your vision is not badly affected and you don't have any difficulties carrying out everyday tasks such as reading or driving. New glasses, brighter lighting, anti-glare sunglasses and magnifying lenses help reduce the impact of cataracts. Surgery should only be offered if you have cataracts that are affecting your ability to carry out daily activities. How well can you see? Visual acuity is about how well you see detail. This is usually measured using a chart with rows of letters. During an eye test, you sit 6 metres from the chart. If you can only read the big letter on the top line, that is scored as 6/60. To drive a car, you must have a visual acuity of 6/12 or less. 9
If we change the eligibility One cataract surgery would only be funded if: Your visual acuity is 6/12 or worse and you have one of these problems: Less mobility or difficulty driving because of your cataract. Your ability to work, give care or live independently is affected. If you have diabetes, or an eye condition which requires clear views of your eye to monitor the disease or treatment If you have had glaucoma which requires cataract surgery to control the eye s fluid pressure If you have a certain type of cataract and have problems with glare and or bright conditions If your vision makes it borderline whether you should drive Two cataract surgeries would only be funded if: The first surgery does not achieve a visual acuity of 6/9 or better, and the doctor can put a case for the patient's individual circumstances. or The patient has diabetes, or an eye condition which requires clear views of their eye to monitor their disease or The patient is left with any condition meaning that their eyes don t work well together which is uncomfortable We believe that these changes could save us 661,858. 10
Podiatry We re thinking about limiting who can have NHS-funded routine podiatry such as toenail cutting, so that it would only be available to people who have medical condition such as diabetes or arthritis. We spend around 3.26 million a year on podiatry services. Some of our GPs tell us they find it hard to find podiatric care for people who need it. It s hard to tell how many people use podiatry services (as some people use the services regularly) but we think there were around 44,625 episodes of podiatric care last year. This high number suggests that while we re spending a lot on podiatry, the people who need it aren t always getting it. As part of this, we want to limit NHS funded routine podiatric care so only people who are at risk because of their medical conditions, such as people with diabetes and rheumatoid arthritis, would be eligible for NHS-funded routine podiatric care. We think this change could save us 653,498 a year. Possible savings If we did everything in this document, these changes could save us around 4 million a year: Area Possible saving NHS prescribing 575,280 Stopping funding: Ear wax removal Some injections for lower back pain Osteopathy Limiting access to: Cataract surgery Podiatry 403,259 1,281,358 444,000 661,858 653,498 11
What do you think? You can let us know what you think in lots of ways: To find out more and fill in the online questionnaire visit online: www.barkingdagenhamccg.nhs.uk/spending-wisely www.haveringccg.nhs.uk/spending-wisely www.redbridgeccg.nhs.uk/spending-wisely Send us an email: haveyoursay.bhr@nhs.net Call us: 020 3688 1615 Write to us: FREEPOSTBHR CCGs If you d like us to come out and talk to your group about this, please let us know. Remember to let us know what you think by: 5pm on 15 November 2017. If you need help filling in the feedback form, let us know and we will find someone to help you. NOTE: We ask these questions because we need to understand who has completing this form to make sure we get as many different views as possible. 12
Are you? Tick Tick Male Other Female Prefer not to say How old are you? Tick Tick Under 18 55 to 64 18 to 24 65 to 74 25 to 34 75 or older 35 to 44 Prefer not to say 45 to 54 Are you disabled? Tick Tick Physical/ mobility issue Learning/ mental health issue Visual impairment Hearing problems Another issue Where do you live? Tick Tick Barking and Redbridge Dagenham Havering Other (which area?) If you have ticked Other please tell us which area here: No What background are you from? This is not about where you were born. It s about the group you think you belong to. Any white background Tick Any mixed background Any Asian background Any black background Any other group. Please tell us what? Are you telling us your thoughts as: Prefer not to say A local person On behalf of an organisation or group If so, which? A healthcare professional Someone who would be affected by the changes Other If so, why? Tick 13
Prescribing 1. What do you think about no longer giving prescriptions for these things: support Support Don t mind Against against Antimalarial medicine Threadworm medicine Sleeping tablets Hayfever medicine Travel sickness medicine Vitamin D Probiotic supplements Bath oils, shower gels and shampoo Skin rash creams Sunscreens 14
Is there anything else you want to tell us, or think we should consider before making decisions about no longer prescribing these medicines? Ear wax removal 2. Please tell us what you think: support Support Don t mind Against against The local NHS should stop paying for ear wax removal Is there anything else you want to tell us, or think we should consider before making decisions about this? Injections for lower back pain 3. Please tell us what you think: support Support Don t mind Against against The local NHS should stop paying for spinal disc injections The local NHS should stop paying for facet joint injections 15
The local NHS should stop paying for epidural injections Is there anything else you want to tell us, or think we should consider before making decisions about this? Osteopathy 4. Please tell us what you think: support Support Don t mind Against against The local NHS should stop paying for osteopathy Is there anything else you want to tell us, or think we should consider before making decisions about this? Cataract surgery 5. Please tell us what you think: support Support Don t mind Against against The local NHS should tighten the eligibility criteria for cataract surgery 16
Is there anything else you want to tell us, or think we should consider before making decisions about this? 17
Podiatry services 6. Please tell us what you think: support Support Don t mind Against against The local NHS should tighten the eligibility criteria for podiatry Routine podiatric care should only be funded for people who have a medical condition. Is there anything else you want to tell us, or think we should consider before making decisions about this? General 7. In the last two years have you or a member of your close family: Yes No Had ear wax removal paid for the NHS? Had injections for back pain? Had treatment from an NHS-funded osteopath Had routine podiatry (corn, toe nail cutting) paid for by the NHS? Had NHS-funded cataract surgery 18
8. Are there any other things you can think of to help save us money? Or do you have any other comment you would like to make? Your comments here 9. If you would like us to tell you what decisions we make about these proposals, please write your name and email address in the box below. We will keep your details safe and won t share them. Thank you for taking the time to let us know what you think. 19
Words List Word Cataract CCG Complementary or alternative medicines Consultation Criteria Diabetes Disc Eligibility Epidural Facet joint Glaucoma Gluten-free GP Hayfever IVF Malaria Musculoskeletal Meaning Cloudiness of the eye lens Clinical commissioning group. A group that buys in medical services. Medicines that are not always based on scientific evidence A way of asking people what they think of our ideas to change the way we do things A set of standards which something is judged against A long-term condition that causes a person's blood sugar level to become too high Circular pads of connective tissue between the vertebrae (backbone) of the spine Whether someone qualifies. In this case, the minimum criteria to access a procedure An injection into the back Small joints located between and behind the vertebrae (backbone) of the spine Eye condition where the optic nerve, which connects the eye to the brain, becomes damaged Wheat (and other related grains) free diet General practitioner Pollen and dust allergy In-vitro fertilisation. A way to help people who are struggling to get pregnant. A serious tropical disease spread by mosquitoes The nerves, tendons, muscles and supporting structures, such as the discs in your back 20
Osteopathy Podiatry Probiotics Rheumatoid arthritis Sterilisation Sunscreens Threadworms Varicose vein Visual acuity Vitamin D A way of detecting, treating and preventing health problems by moving, stretching and massaging a person's muscles and joints A branch of medicine devoted to the treatment of feet, ankles and lower legs Products containing live bacteria and yeasts, such as some yogurts and yogurt based drinks A long-term condition that causes pain, swelling and stiffness in the joints Surgery to make a person unable to have children Lotions and creams that protect you from the sun Tiny worms that infect the intestines of humans Enlarged veins that have become twisted How clearly you see A vitamin that is needed for strong bones 21