What is “Limited clinical benefit”?

The South West Strategic Health Authority document, “Progress report on plans forimproving quality, innovation, productivity and prevention ”, dated January 7th this year, makes estimates of how cuts in funding would be shared out in the South West. One of the potential areas of saving was listed as “reducing procedures of limited clinical benefit”. The document estimated a saving of £40-44 million. What were these procedures “of limited clinical benefit”? The document said this would involve “savings from decommissioning a standardised list of low priority procedures of limited clinical benefit without prior approval – i.e. minor skin procedures, liposuction, removal of tattoos, cosmetic orthodontics, minor ear procedures, varicose veins etc.”

At the time I read this I must confess to being suspicious that “procedures of limited clinical benefit” might include treatments which whilst not life threatening could be problematic to patients who would be denied treatment. Varicose veins, for instance can be painful. This is one of the questions that Swindon TUC has asked of the SWSHA in a Freedom of Information application (we are currently awaiting their response).

In yesterday’s Guardian letters page there was a letter which cast some light on this issue. Under the heading “Cuts in the NHS are already happening”, it read:

Primary care trusts are restricting patient access to many treatments in order to save money (Darling: we will cut deeper than Thatcher, 26 March). Across the country, thousands of patients attend their GP surgeries with conditions that can be effectively treated by surgery and are being turned away. Some patients may not even be told that an operation can help their problem. Those patients who are referred to a specialist may now find that they are refused funding for surgery by their PCTs, which have arbitrarily defined a number of operations that reduce pain, improve quality of life and prevent serious long term complications as being of “limited clinical value”.

These cuts are being made without public consultation and the responsibility for informing patients denied treatment is being left at the doors of doctors. It is unfair to patients and NHS staff to maintain the facade that this is “business as usual”. All who work in the NHS are aware of the serious financial crisis facing public services, but careful decisions need to be made to ensure patients benefit from reliable treatments. Currently the public is not being fairly or fully informed.

Alan Johnson, President, ENT UK, Prof Michael Horrocks, President Association of Surgeons, Michael Bell, President British Orthopaedic Association, Michael Rhodes, President of Laporoscopic Surgeons, Michael Parker, Past-President, Association of Laporoscopic Surgeons and President-elect, Association of Coloproctology, John Black, President, Royal College of Surgeons of England.”

We will write at greater length on the wide range of “efficiencies” that are being pushed through. The professionals are right to be concerned that decisions on what constitute “limited clinical value” should not be determined without public consultation. The scale of the cuts being proposed has barely sunk into public consciousness as yet.

The SWSHA document says that: “The challenge for the NHS is to manage growing demand, improve quality and patient safety and save money all at the same time ”. What is patently clear is that to do all these things whilst slashing funding is impossible.

Who can doubt, after hearing the three Chancellors or would-be Chancellors agreeing, that the cuts must be deeper that those carried out by Thatcher, that supporters of the NHS as a public service have a big job on their hands in resisting these cuts, and in the first instance alerting the public to the unprecedented scale of them.

Martin Wicks

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