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NHS “efficiency savings” achieved by cutting cataract and hip ops

As rationing increases, GPs are referring more patients to the private sector

Under the McKinsey "efficiency savings", the NHS must save £20bn over the next five years. This is portrayed as a drive to improve productivity by 4% each year, but in reality the "savings" are as much about reducing the cash spent, as how efficiently that cash is spent.  

Five years ago, Croydon Primary Care Trust collated a list of 34 procedures not necessarily performed for medical reasons and which could be restricted in cases where they were ineffective or cosmetic. The London Health Observatory analysed the Croydon List and estimated the savings. Some procedures on the list are less contentious: the NHS can save money by no longer removing tattoos, skin tags or benign moles, and in these austere times there is a powerful political argument for the NHS to cease funding such cosmetic surgery.

But the Croydon List also includes non-cosmetic procedures with the justification that the benefits are considered minimal in "mild" cases. Such procedures include surgery for cataracts, hips and knees, which can all make a real difference to the lives of patients. Since last summer several PCTs have restricted the care they will fund according to the Croydon List. In some areas only "urgent" treatment – cancer, fractures and A&E – are funded, and all other procedures are either delayed or the patient is denied funding.

Last week the Federation of Surgical Speciality Associations published an open letter expressing concerns about this rationing of care, and, significantly, they point out that there is "little or no evidence to support the view that many of the procedures are of limited value to individual patients".

Last week the Guardian reported a survey of GPs showing significant cuts in the numbers of patients referred for procedures on the Croydon List. In the survey 70% of GPs were seeing reductions in referrals for weight-loss treatments, 40% restrictions in ophthalmology services and 30% said there were restrictions on orthopaedic services.

GPs are either being told by their commissioning PCTs to restrict referrals, or are having their referral decisions overridden by referral management or clinical review systems. As a consequence GPs, with the best interest of their patients, are looking towards the private sector to provide these procedures, funded by the patient or their medical insurance. The Guardian reports that half of GPs ask their patients if they have private medical insurance and a third of GPs plan to make more private referrals this year.

The £20bn "efficiency savings" will be difficult to achieve through productivity gains or by ceasing to fund cosmetic procedures. It is clear that a significant proportion of the "savings" will be achieved through healthcare rationing. There is no justification for the denial of medical procedures on the NHS. Any rise in the number of such self-funded procedures in the private sector should be taken as a failure by the government to deliver a comprehensive, universal healthcare system.

Richard Blogger analyses the NHS at Conservative Policies Dissected.

Richard Blogger writes about the NHS and social policy at NHS Vault.


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