Creating a new NHS England: Health Education England, NHS Digital and NHS England have merged. Learn more.
Consultation on Specialised Services clinical commissioning policies and service specifications
NHS England has today (26 February 2016) launched a 30 day public consultation on a number of proposed new products for specialised services, (including service specifications and clinical commissioning policies).
There has already been extensive engagement on these national specifications and policies. They have been developed with the support and input of lead clinicians and tested with stakeholders. This approach has helped ensure that the views of key stakeholders have informed and influenced the development of the specifications and policies to date.
Please note this is one of several public consultations on a proposed new draft products for specialised services. We now wish to test them further with wider stakeholders through public consultation.
There is very little robust evidence of one procedure compared with another (other than cases of Klinefelter’s Syndrome or confirmed Y chromosome microdeletion a, b). There has been no presentation of comparative procedural costs that are proposing to be commissioned whilst comparing them with potential chance of success. This would be extremely useful information in determining a cost effective strategy.
I would fully support the proposal that funding for either gamete use in IVF/ICSI or storage is confirmed beforehand. However it seems to have been overlooked that “Urologists” have no experience or knowledge in the commissioning process regarding IVF / fertility services. Eligibility funding is based on a couples situation and complete investigation of both the male and female patient. Urologists as a rule do not have the appropriate expertise or resource to assess a couples fertility. They are also unaware of the processes pertaining to fertility commissioning policies and processes and would require significant input from the reproductive medicine specialists. Therefore the referral onward to an IVF specialist if surgical sperm retrieval was successful seems a little too late. Tertiary fertility units should be involved at an earlier stage in patients care, possibly even before SSR is considered an option. The process necessitates a far more interdisciplinary role between reproductive physicians and urologists than the proposed policy suggests.
The vast majority of males with azoospermia are identified in secondary and tertiary fertility units, rather than urology clinics.
Subspecialists in reproductive medicine and surgery (RCOG Accreditation) have specific training in a number of Surgical Sperm Retrieval procedures (PESA,TESE, TESA ). They are ideally placed within the patients care pathway and have the appropriate surgical expertise and can provide total and complete care for the patient and couple. There is no published evidence that suggests complication rates are higher or success rates lower when the procedures are performed by a subspecialist in reproductive medicine compared with a urology surgeon. However I think all subspecialists appreciate that mTESE and MESA should be performed by Urologists with the appropriate expertise, as they are more complex procedures.
I work with individuals with long term neurological difficulties such as spinal cord injury. There is a dearth of services to provide treatment once they are discharged into the community. For example Sefton has 1 community physio who can only treat COPD patients. My client, a 65 yr old female, with C5 injury requires a chest clearance however, there are no services in the community to meet her needs. Furthermore, CHC have commissioned social care of just 4 hours per day. This lady should have 24 hour care. In Preston/Lancashire CHC) I have a similar patient who had 26 hours commissioned. How can there be such a disparity between CHC’s. There is still a post code lottery as to the provision of services across trusts. I suggest guidelines (underpinned by LTC Framework) or a standardised pathway that travels with the individual through the NHS into the community. Services, based on best practice guidelines, should be provided to individuals regardless of where they live to ensure a uniform and safe approach to integrated care in the community.