Indicriminate Rationing: Cataracts are just the thin edge of the wedge

The Post Code nature of locality indiscriminate rationing means that the poorest half of the country will be asked to wait, whilst the richest half will pay. Just as they do for dentistry: patients are being levered into paying, either directly, or by insurance. The Commissioners are put in an invidious situation where life saving procedures are more important than cataracts, and they have to stay within their budgets without “rationing” officially, as this term is not allowed. So long term priorities and perverse incentives dictate that cataracts are unavailable to many people on their version of the UK’s Health Service. The result: less independence, less quality of life, more chance of falls, more depression, and possibly more chance of dementia as stimulation of all sorts helps delay. Remember there is no “N” HS, and the media and politicians are colluding to pretend there is. NHSreality feels that devolution has not helped health care, where being part of a large mutual is most important.

When will the debate on rationing overtly take place ?

March 20th 2019 in the Times. Chris Smyth reports: Cataract surgery doesn’t work, says NHS in cost‑cutting drive

Patients in half of the country are being denied cataract removal operations by NHS cost-cutting policies that wrongly suggest the surgery does not work, according to a study.

People needing hernia surgery and hip replacements are also routinely refused care by “indiscriminate rationing” policies that class common treatments as ineffective, it concluded.

Doctors and campaigners have condemned the policies as “wrong” and “shocking” but health chiefs said that they did not have the money to treat everyone. Cataract removal is the most common procedure carried out by the NHS, with 300,000 operations a year.

In 2017 the National Institute for Health and Care Excellence concluded that cataract surgery was virtually always a good use of NHS resources because patients who struggle to see are more likely to injure themselves. Its guidance demanded the health service end rationing of the 20-minute procedure that restores sight.

A study by the Medical Technology Group, a forum for patient charities and device manufacturers, found that 104 of 195 clinical commissioning groups (CCGs) that pay for care locally are classing cataracts as “procedures of low clinical value”, in defiance of the Nice guidance.

This means that they will not fund them unless doctors make an exceptional case for individual patients. The figure includes a third of groups that pay for surgery only when patients’ vision has deteriorated past a certain point.

Barbara Harpham, chairwoman of the group, said: “It’s simply not fair that patients up and down the country are being denied access to vital treatments because of where they live. This indiscriminate rationing by local NHS organisations must stop now.”

Helen Lee, of the Royal National Institute of Blind People, said: “It’s shocking that access to this life-changing surgery is being unnecessarily restricted.” Mike Burdon, president of the Royal College of Ophthalmologists, said that there was no justification for the policies: “CCGs must take notice of the Nice recommendations which reinforce the message that cataract surgery should be delivered at point of clinical need. It is one of the most efficient procedures in the health service.”

The survey also found that 78 groups class hip and knee replacements of limited clinical value and 95 limit access to hernia repair via the same method or in policies that say surgery must be delayed for more tests. Twenty-five CCGs limit all three procedures. Bedfordshire also restricts continuous glucose monitoring for diabetics.

The Royal College of Surgeons said: “It is wrong to label hip and knee replacements, and hernia surgery, as of limited value. With the NHS about to receive a cash boost in April, we need a clear message from government that restricting such treatment is wrong.”

The NHS Clinical Commissioners, which represents CCGs, said: “The NHS does not have unlimited resources and ensuring patients get the best possible care against a backdrop of spiralling demands, competing priorities and increasing financial pressures is one of the biggest issues CCGs face.

“They are forced to make difficult decisions that balance the needs of the individual against those of their entire local population. There are tough choices to be made, which we appreciate can be difficult for some patients.”

The Telegraph: More than half of NHS authorities rationing cataract operations

The Express: Outrage over NHS postcode lottery for eye and hip operations

The Express comments: That means it is wrong that the quality of care and access to treatment should be different depending on where you live. After all, we all pay the same taxes for it, so we all deserve the same access to treatment. Therefore, the latest revelations on the scourge of the so-called postcode lottery is another sad reminder of a variable quality of care.

This entry was posted in A Personal View, Commissioning, Dentists, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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