Hospital Dr News

“Need not cost to determine routine surgery”

A royal college has called on NHS England to investigate a CCG which is proposing to limit access to surgical services.

Devon CCG has said it will deny routine surgery to smokers and the morbidly obese unless they quit or lose weight.

The GP-led Northern, Eastern and Western Devon Clinical Commissioning Group says the measures are “urgent and necessary” as it faces a £14.5m deficit and needs to reduce costs.

However, Miss Clare Marx, president of the Royal College of Surgeons, said: “Access to routine surgery should always be based on an individual’s clinical need.

“The government has been clear that restricting clinically necessary treatment on the basis of financial considerations is unacceptable. We urge the Department of Health and NHS England to review the situation in Devon if the CCG is indeed intending to deny patients treatment without enabling the clinicians and patients involved to make informed choices about their care.”

Rebecca Harriott, the Devon CCG chief officer, said it would be prioritising services in the NHS Constitution.

The group says hernia treatment, botox injections and cataract operations are also under review.

Ms Harriott said: “We must act to protect essential services through our busiest winter months and ensure that care is there for our patients when they really need it.

“The CCG is working up a series of measures to prioritise those patients most in need, while at the same time, increasing efficiency in the wider system – and the CCG itself.”

RCS’s Marx said that while patients should be encouraged  by their surgeons to take positive steps to improve their own health, especially where it can improve the outcome of their surgery, evidence-based guidance should be used when determining the provision of surgery.

She said: “It is unacceptable for any CCG to have a blanket ban on elective surgery for people above a certain weight – a patient may have made substantial efforts and been successful in losing weight but in some cases it might be difficult for a patient to continue to lose weight without, for example, a hip or knee operation.”

The college pointed to its commissioning guidance, accredited by NICE, to support CCGs when commissioning surgery.

The Devon CCG is also looking to reduce unnecessary consultant to consultant referrals, and suspend treatments where there is little or poor evidence of outcomes.

Meanwhile, health secretary Jeremy Hunt said the NHS had to make  £22bn of further savings as part of the ‘Forward View challenge’. This follows the £20bn already saved under the ‘Nicholson Challenge’.

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