Health chiefs set to review ‘low priority’ treatments
New NHS policy unveiled that could mean patients wait longer
Published: 10 June, 2010
by RICHARD OSLEY
HEALTH chiefs are to scrutinise what they spend on treating what they see as “low priority” ailments and medical procedures.
A new policy will operate across north London health trusts to reduce treatments not deemed cost effective.
There are fears patients who are not considered “special cases” may have to wait longer or miss out on treatments such as dental implants and minor oral surgery. Help for Chronic Fatigue Syndrome will also be reviewed.
The policy was agreed by the Joint Committee of Primary Care Trusts in February and expands a list which was already in place in Camden and includes tonsil removals, carpal tunnel syndrome treatment and surgical treatment for sinusitis.
The review does not mean that medical attention will not be dispensed, but it does mean patients will have to meet more stringent criteria before being referred through for treatment.
Lib Dem councillor John Bryant, chairman of the Town Hall’s Health Scrutiny Committee, said he wanted to see the proposals pass through a council review.
“My understanding is that this was a proposal from North Central London Commissioning Team, which covers five boroughs,” he said.
“I am seeking an item on Health Scrutiny for NCL to send a representative to explain what is going on.”
An NHS Camden spokeswoman said: “Consultation on the implementation of the policy is being undertaken at local level by individual PCTs. In Camden the implementation of the Low Priority Treatment policy will not result in a significant change for most of the treatments listed in the policy.
“Receipt of these treatments has long been regulated through the application of Service Access Criteria which uses similar clinical thresholds.
“However, the LPT policy does represent a restriction to some treatments that are currently not covered by Camden’s current Service Access Criteria. Because the adoption of the LPT policy would represent a change in access to these services, NHS Camden has recently initiated discussions on the policy with Camden LINkS in order to consult with them on its implementation.”
LEGAL EYE – Patients should not have to suffer in silence
WITH the new government’s election promise that there would be no cuts to frontline NHS services, it came as a shock to discover Camden NHS has decided to axe 25 treatments currently available under the NHS, save in exceptional circumstances.
It seems that these changes were already in the pipeline before the election so it might be unfair to blame them entirely on the new government. However, it is clearly crucial that people who will now be refused access to certain treatments know what they can do to challenge this decision.
Important questions are raised by the announcement of these cuts for both patients and potential patients about whether they should have had a say in the changes made to NHS services, or whether they only need to find out about them once implemented.
The law requires NHS bodies like NHS Camden to involve or consult health service users (or potential users) either directly or through representatives in the: planning of service provision, development/ consideration of proposals to change service provision and decision-making process regarding the operation of those services.
NHS guidance on this issue clearly states that: “Users must be involved not only in the consideration of proposals to change services, but also in the development of any proposal that will change the manner in which a health service is provided or the range of services offered.”
In this case it seems that the change in policy was referred to Camden LINk which raised some limited concerns about it. LINks are bodies set up by the government to provide a contact between the NHS body and the community. Unfortunately the LINk does not appear to have publicised these cuts either across the whole community or more specifically to groups which would be directly affected. Whether in these circumstances the referral to Camden LINk was enough to satisfy NHS Camden’s duty to consult or involve is questionable. It is arguable that NHS Camden should have consulted or involved patients more widely itself. This question has never been decided by the courts.
In addition, when NHS Camden is considering “a proposal for a substantial development of the local health service or a substantial variation of local provision” it must consult Camden Council’s Health Scrutiny Committee. This does not seem to have happened here either. It is likely that NHS Camden would say they did not refer it to the council’s scrutiny committee because the proposal did not envisage a sufficiently “substantial” change to the service. However, this conclusion too seems questionable and again the courts have yet to decide exactly when proposed changes to NHS services need to be referred.
To come to a view about whether NHS Camden has acted unlawfully in failing to involve patients or Camden’s Heath Scrutiny in its decision making, it would be necessary to have a clearer idea of the impact of the new policy on patients. The introduction of the new policy could be challenged in the courts by affected patients, forcing NHS Camden to go back and consult more widely.
• Richard Stein is a senior solicitor at Leigh Day and Co and a former Camden councillor