More than 100,000 patients are slated to get some negative news from their doctor in the upcoming year if a new proposal set to reduce “risky” and “ineffective” treatment options is approved. Under the new guidance from NICE, NHS is limiting the procedures available to patients with a variety of medical conditions, from back pain to varicose veins. The updated guidelines for what is – and what is not – allowed through NHS hospitals comes at a time when the healthcare organisation is under severe scrutiny surrounding budget cuts and patient care. Many believe that the latest announcement covering the reduction of perceived unnecessary services could potentially cost the government more in funding in the years ahead while impacting the quality of care patients receive through NHS facilities now.
Which Treatments are Included?
Under the new proposal, which would not take effect until late 2019 or early 2020 if approved, includes several voluntary procedures that are deemed out-of-date, or that do not have enough benefit to the patient to outweigh the risks involved. These procedures include a total of 17 that may ultimately be removed from NHS offerings. However, there are distinctions between some of the treatment options that allow for their performance. Four treatments, including surgery for snoring, dilatation and curettage for heavy menstrual bleeding, knee arthroscopies for osteoarthritis, and injections for non-specific back pain may still be offered, but only when a patient makes an individual request.
However, the remaining 13 procedures in the latest restriction list include a wide range of treatment options for patients currently that may be covered when specific criteria are met. These treatments are:
- Breast reduction surgery
- Removal of benign skin lesions
- Grommets for glue ear
- Tonsillectomy for sore throats
- Haemorrhoid surgery
- Hysterectomy for heavy menstrual bleeding
- Eyelid lesion removal
- Bone spur removal for shoulder pain
- Carpal tunnel syndrome release
- Contracture release for tightening fingers
- Removal of noncancerous lumps on the hand or wrist
- Trigger finger release
- Varicose vein surgery
For each treatment, patients must request the procedure directly with their GP or specialist, and then an approval process will take place. For some patients, the removal of these treatment options unless certain criteria are met may mean they are left in pain without any recourse of easing symptoms. They may also experience worsening medical conditions related to their original condition in the future which could result in further need for care.
Effects on Patient Care
Although some of the treatments included in the potential restriction list may prove harmful to patients when they do not have a pressing need, others do not fall so easily into that category. Eddie Chaloner, specialist in varicose vein treatments, explains that for varicose veins specifically, NHS treatment options have been moving toward a more limited menu of offerings for some time. Part of this is due to the fact that NHS providers grade varicose veins on a scale from one to six. Grade one veins are seen as cosmetic issues only, not requiring vein surgery for treatment. Grades four through six are severe enough to cause pain and discomfort in most patients, although describing that pain to a GP can be a challenge. For several years, only patients higher up the grade scale have been recommended for varicose vein surgery as a corrective measure.
Less severe varicose vein patients have been suggested to try at-home treatment options, including compression stockings which can be uncomfortable, elevation of the legs, and pain medication for persistent discomfort. While these remedies can help ease some of the issues related to varicose veins, they are not often as successful as up-to-date vein surgeries. Chaloner explains that reducing the number of patients offered vein surgery may create a situation where more individuals have complications with vein disease in the future. Denying procedures now will ultimately increase the cost of more complex treatments for NHS down the line.
Similar concerns exist among patient advocacy groups and healthcare leaders throughout the UK, specifically relating to the long-term implications on treatment restrictions. While the millions saved in the immediate term may be refocused on cancer care and preventative measures across NHS facilities, the lack of options for mild conditions has a potential to increase pressure on providers in years to come. While the proposed list of restricted treatments is under review, patients can take a proactive step in speaking with their doctor or specialist now about viable treatment options.
