We do have a choice, both as individuals (to pay or not to pay) and as a Nation. To ration overtly or to ration covertly.  This trust was wriggling on the hook of financial bankruptcy, and like Wales was unable to afford to pay Chester until the bailout, they are unable to fund comprehensive care.

The Mirror reports 20th June 2019 that Warrington and Halton Hospital Trust have tried to initiate payment schemes for operations that have formerly been free. £18K for a hip. By the end of today the Trust had changed it’s approach, and returned to the standard political speak “Everything for everyone for ever”, which of course is unsustainable. Better to ration high volume low cost treatments and services that patients can usually afford, than low volume high cost treatments that everyone assumes is included in the safety net.

By the end of the day the Mirror on line headlined: “Hospital stops plan to charge patients”.

EXCLUSIVE : Warrington and Halton Hospitals Trust has announced a ‘pause’ of of the My Choice service which the Daily Mirror exposed on it’s front page today

Update: 20th June 2019

The Trust are pausing the availability of this service and reviewing it to ensure it can in no way disadvantage NHS patients. To date, no NHS patients have been impacted as no one has been treated as part of the My Choice service. The Trust continues to meet all of its diagnostic, cancer and referral to treatment standards.

My Choice scheme and current media coverage

You may be aware of the current media coverage regarding the above scheme. I would like to reassure you about this. For the avoidance of doubt, I would wish to be very clear that Warrington and Halton Hospitals NHS Foundation Trust does not charge NHS patients for NHS treatments and we have no intention of doing otherwise. It is not the role of hospitals to determine which treatments are funded by the NHS and which are not; this is the role of NHS commissioners.

Present for many years, there is a growing list of procedures that our commissioners will no longer pay for if criteria are not met. The Trust does not make decisions with regards to eligibility for such procedures. There is a national list, locally implemented by commissioners. Initially this list was referred to as Procedures of Limited Clinical Value (PLCV); this then became Procedures of Lower Clinical Priority (PLCP) and these are now referred to as Criteria Based Clinical Treatments (CBCT). They emerge from evidence-based guidelines, reflecting the changing nature of clinical practice over the years and the focus on evidence-based medicine and clinical effectiveness. The list of procedures, set by commissioners, includes commonly undertaken operations such as hip and knee replacements and cataract removal.

These remain available on the NHS in the usual way if the criteria are met, as is usually the case. We are now also able to offer these procedures via our My Choice service to make them more accessible for patients who otherwise would not qualify for them under commissioner guidelines. If a patient does not meet the criteria laid out by commissioners, patients have two choices: they can either seek the procedure through the private sector or not have the procedure at all. What we are trying to do, like many others, is to improve the offer for patients with a third choice if they do not meet the criteria required by commissioners; that is to self-fund their procedure within their local NHS hospital at a cost that is potentially more affordable than the private sector, at a price based on the NHS national tariff.

Each case is of course an individual clinical consideration on its own merits with conversations about the risks and benefits of procedures occurring between patients and clinicians as is standard practice. The Trust relaunched the My Choice service in September 2018. To date no patients have been treated under this scheme. Once again, our Trust does not charge NHS patients for NHS treatments; it is the role of the commissioners to determine which patients are eligible (and funded) for which treatment and which are not. Our role, as ever, is to provide safe, high quality healthcare in a way that is sustainable for the future of our local population.


This entry was posted in A Personal View, 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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