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Consultation on Specialised Services clinical commissioning policies and service specifications

NHS England launched (04 April 2016) a 30 day public consultation on a number of proposed new products for specialised services (including service specifications and clinical commissioning policies), in an addition a 60 day public consultation has also been launched for the use of Hyperbaric Oxygen Therapy clinical commissioning policy.

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.

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16 comments

  1. Nicola Foster says:

    As a Student, I have been researching HBOT as part of my H&SC course. Initially I found it incredible that NHS England could write such a consultation document virtually dismissing out-of-hand all the overseas studies and home efforts by the Multiple Sclerosis Society, Macmillan Cancer Support and others.
    I suggest they look at http://www.hbot.com/article/phase-i-study-lp-hbot-blast-induced-tbi-pcs-and-ptsd, for example, to show how much HBOT can help mental, never mind physical, health problems.
    Even our 2012 Olympic Squad used HBOT to get an injured athlete back to peak physical health in record time – so if it’s good enough for our elite, surely it must be good enough (and available)for the rest of us??

  2. My name is Helen Gelly, MD, FACCWS, FUHM, UHM/ABPM. I have been in hyperbaric practice since 1991, and have seen first hand the effect of hyperbaric oxygen therapy has on patient lives and the impact on their quality of life.
    Please listen to actual patients discuss their cases: Cancer Survivors

    This week I am joined by two cancer survivors who successfully beat their cancers but ended up as part of the group of patients who have problems where they received radiation therapy, called “late effects of radiation”. For most patients who experience these issues the symptoms they experience get better with a few weeks of time and conservative measures. But for some, they persist and can have significant impact on quality of life. The symptoms these patients experience depend upon where the radiation was administered on to the body. They can include non-healing wounds on the gums, sometimes exposing the jaw bone (mandible), necrosis (cell death) of the jaw bone, breast pain, chronic diarrhea, bleeding with urination or bowel movements, bladder pain, painful bowel movements, and sensations of urinary and/or bowel frequency and urgency. Hear how they were able to successfully treat their late effects of radiation with hyperbaric oxygen therapy. LISTEN to this podcast:
    http://topdocs.businessradiox.com/2014/07/09/cancer-survivors-discuss-late-effects-of-radiation/

    Thank you

  3. Dr Karl Blenk says:

    I am shocked by the suggestion to chnage funding to Hyperbaric oxigen services and even more by the ommision of important recent findings.

    Could I draw your attention to the recent Cochrane review into the beneficial effect of HBO therapy on post rediation necrosis?

    “A U T H O R S ’ C O N C L U S I O N S
    Implications for practice
    There is some evidence of moderate quality that hyperbaric oxygen therapy (HBOT) improves outcome in late radiation tissue injury (LRTI) affecting bone and soft tissues of the head and neck, for radiation proctitis and to prevent the development of osteoradionecrosis following tooth extraction in an irradiated field”

    I also have the impression that the

    Scottish Systematic Review 2

    The clinical and cost effectiveness of hyperbaric
    oxygen therapy from 2008:

    HTA programme: Systematic Review 2 – July 2008
    The clinical and cost effectiveness of hyperbaric oxygen therapy
    Authors: Ritchie K, Baxter S, Craig J, Macpherson K, Mandava L, McIntosh H, Wilson S

    “Carbon monoxide (CO) poisoning HBOT is strongly recommended for patients
    with diagnosed CO poisoning, who are at high risk (unconscious; clinical neurological, cardiac, respiratory or psychological symptoms”

    Many other reviews have concentrated on the half life time of Carbomonoxide under HBO compared to normobaric O2

    This misses the point. The aim of HBO treatment in CO poisening is the prevention/amelioration of long term neurological sequelae

  4. Dolores Mateo says:

    The latest experts consensus released by the European Committee of Hyperbaric Medicine at their latest conference makes it clear that although there is some evidence to use hyperbaric oxygen therapy (HBOT) for decompression illness and gas embolism, there is even stronger evidence when it comes to conditions such as CO poisoning and prevention and treatment of osteoradionecrosis. It is clear why withdrawing NHS funding for decompression illness and gas embolism would present an obvious contradiction to the cause of both conditions. The outcome of CO Poisoning and osteoradionecrosis can be seen as more subjective and therefore require a more robust evidence to continue the funding. The long term consequences of CO poisoning and osteoradionecrosis can be devastating and massively incapacitating for patients. They can both be the cause of permanent disability and need for permanent social care. This is obviously undesirable for the patients and financially more impacting in the bigger picture than the cost of the treatment (3 HBOT for CO poisoning and 40 for osteoradionecrosis). There is a significant number of other costly treatments based on the same level of evidence which are unquestionably funded by the NHS. It makes sense that these conditions continue to be funded even if this is subjected to regular reviews and further research.

  5. Dr. A.M. says:

    I work in a DGH with a HBO facility and have seen many patients treated for various conditions, e.g. acute or chronic.
    Many have responded well to the treatment and by reducing and/or stopping funding many new patients may not benefit from this additional method of treatment. This will lead to further morbidity in patients who otherwise may have benefited from HBO-treatment.
    Short term savings (as suggested by cutting funding) will only lead to higher costs in treatment in the long term. It makes no sense. Unfortunately the NHS is full of making decisions for short term savings.

  6. Brian says:

    After a multiple fracture to my pelvis and other more serious injuries following a pleasure horse riding accident in the UK in the Cheltenham-week 2015, on 10th day afterwards I transferred to Dublin so that on the 11th day I could commence hyperbaric oxygen therapy (HBOT) in the private National Hyperbaric Centre. I had known that professional jockeys used HBOT. I believe that I spent 50% of the time in a wheelchair that my doctors originally predicted. I believe that I was back to work months earlier. My skin had never been better in all my life as I also believe that it healed my life long problems with both acne and asthma. I know that medically, spontaneous improvements can only be ruled out by doing clinical trials. Drug companies will not pay for such trials as they cannot patent the treatment. I personally met a man who showed me a series of photographs he had laminated illustrating his diabetic foot as it healed from HBOT and he said he did this as he wanted to ‘spread the word’ about the treatment. He was angry that he had lost the five toes on his other foot through ignorance. I am giving the HSE my email address to help further if needed.

  7. Paul says:

    After treatment for throat cancer i was left with lythadema in my neck,a throat so sore had to take morpheen every time to drink or eat after 5 days of 1 hour sesions in chaber swelling in neck gone throat back to normal. NHS docters said it could be up to 3 years for throat to heal, could not believe how my throat had healed after treatment

  8. Andreas says:

    seen many patients with acute and chronic conditions responding really well often in combination with other specialities.
    sadly often time plays an important role and delay for treatment reduces the chance for a better outcome – working in the field of HBO for many years the vast research results should be evaluated by colleagues with experience in this treatment modality and an unbiased attitude towards it. Indications and funding should be rather made clearer and predictable including international guidelines and expertise – it looks as if short lived savings are aimed for instaed of looking into the overall circumstances eg in treatment of diabetic ulcers or CO poisoning.

  9. John says:

    It is very obvious to both patients and medical professional alike that HBO therapy has a positive impact on many types of ailments but what gets in the way is politics and funding which I would liken to the government and councils strategy for potholes.

    I am a medical professional and feel privileged to have worked in this area for the past 5 years.

    All you have to do is come down and listen to the patients stories, after all they are the ones that count.

  10. Tim says:

    I work all over the world teaching hyperbaric medicine, much of the time in third world countries. When I see new investment in hyperbaric I always ask them why, and the reply is always the same;
    It saves limbs,
    It saves lives,
    It saves money.
    It a shame the NHS hasn’t the intelligence to at least pick up more the last issue!

  11. Dathan Hughes says:

    Hyperbaric Oxygen Therapy is an underused asset accessible to the NHS.

  12. Anonymous says:

    How can this happen during purdah?

    • NHS England says:

      Thank you for your comment.

      NHS England will be following the Cabinet Office pre-election guidance which comes into effect on 14 April in relation to the local elections being held in England in May. This can be found on the GOV.UK website.

      Kind Regards
      NHS England

  13. Theresa Travis says:

    Fantastic forward Thinking

  14. Leah O'Sullivan says:

    These consultations are wave 10 and 11 and the previous one recieved on the 24th March was wave 8. What has happened to wave 9? Have we missed one?