NHS England action to stop patients undergoing ineffective and risky treatments

NHS England has today set out plans to curb ineffective or risky medical treatments given to hundreds of thousands of patients each year.

NHS England’s board of directors will meet next week to discuss proposals to stop or reduce routine commissioning of 17 interventions, including breast reductions and snoring surgery, where less invasive, safer treatments are available and just as effective.

The plans for consultation are the first step in a new programme to prevent unnecessary pain and inconvenience, curb waste and free up resources for frontline care, and have been developed with and are supported by partner organisations including leading health professionals.

Patients would be spared more than 100,000 unnecessary procedures a year, freeing up an estimated £200 million that can be spent on more effective treatments.

It follows similar steps to invest in the most effective treatments across the NHS, with reviews last year to free up £190 million from over the counter medications and a further £100 million by reducing the provision of low value medications.

NHS England National Medical Director Professor Stephen Powis said: “If we want the very best clinical care for our patients, we need to stop putting them through treatments where risks and harms outweigh the benefits. By reducing unnecessary or risky procedures for some patients we can get better outcomes while reducing waste and targeting resource to where it is most needed.

Simon Stevens, NHS England Chief Executive, said: “The NHS is already independently ranked as one of the most efficient health services in the world. But with more money about to go in, we’re going to step up reform to drive remaining waste out. Precisely because the NHS is owned by the public, all the savings we now make will be directly reinvested in better frontline cancer, mental health and other critical services.”

The National Institute for Health and Care Excellence (NICE), which advises on the clinical benefits and cost-effectiveness of treatments, has recommended that many of the procedures should be used as a last resort or even not at all, due to harmful side-effects.

While the procedures will not be banned outright, NHS England wants to ensure that they are carried out only where there is compelling evidence that they will benefit patients. In most of the 17 interventions to be considered, alternative treatments like physiotherapy, a minor injection or change of diet are likely to be effective. Any patient at risk of serious harm from their condition will continue to be offered treatment, and medical professionals will continue to follow guidelines from NICE when recommending treatment.

Professor Carrie MacEwen, Chair of the Academy of Medical Royal Colleges (AOMRC) said: “In the interests of patient safety, quality of care and the effective use of resources this review has identified a number of interventions which are of limited clinical benefit and therefore of low effective value.  These are evidence based proposals which have been subject to clinical scrutiny. Whilst it has been for individual medical royal colleges or specialist societies to comment on the specific specialty recommendations the Academy of Medical Colleges supports the overall programme which will benefit patients, clinicians and the NHS as a whole by reducing harm and targeting those who will benefit most.”

NHS England will consult publicly on the proposals from July 4th, pending approval by the NHS England board, until September 28th 2018. After the consultation on these proposals is closed, the NHS England board will be asked to approve the final changes, ahead of planning for care delivery in 2019/20.

Earlier this month the government confirmed that the NHS’ budget will rise by an average of 3.4% each year until 2023, and the health service is now developing a 10 year plan to improve care and health services, within the increased funding settlement.

In recent years, the NHS in England has consistently outperformed the overall UK economy’s productivity, and it has saved £27 billion cumulatively over the past five years compared to the NHS’ average funding growth over the rest of its 70 year history.

Dr Graham Jackson, co-chair of NHS Clinical Commissioners, the independent membership organisation for clinical commissioners, said: “We are pleased to partner with NHS England, AOMRC, NHSI, NICE and CQC on this important consultation. This is the start of an ambitious programme of evidence based work to focus on a range of interventions that should not be provided or only provided on the NHS in certain circumstances.”

“There have been a number of attempts to implement this before but this is the first time we have had a national clinical consensus across commissioners, providers and national bodies to make sure the procedures we are offering on the NHS are safe for patients, deliver good outcomes and, are both clinically and cost effective in order to secure the very best value for the limited NHS pound.”

“It is important that we have an honest conversation with the public, patients and clinicians about what can be expected from the NHS within the constrained funds it has available.”