Patients are being denied access to some innovative treatments because of a “lack of pace” and hierarchical decision making by NHS England, it has been claimed.
At least 1,000 patients could have missed out on one of three interventional cardiology procedures to prevent stroke and heart failure after NHS England stopped funding them last year, based on numbers treated in 2012.
As many as 258 children with cerebral palsy will also not have been considered for a treatment that could have improved their mobility, according to an NHS England estimate.
Although these treatments were selected for use under NHS England’s commissioning through evaluation programme last year, no NHS providers have yet been given the green light to resume offering them. They stopped during 2013-14 as NHS England stopped funding them.
HSJ has also learned of a trust that was forced to cease providing two innovative treatments as specialised commissioners at NHS England will no longer fund them.
Chilli patches for the treatment of peripheral neuropathic pain were routinely funded by specialised commissioners before April 2013, while Duodopa, a treatment for patients with advanced Parkinson’s disease that did not responded to other drugs, had been funded on an individual patient basis.
A district general hospital that purchased equipment to carry out robotic surgery has been unable to use it as NHS England is not commissioning providers which were not already delivering the service before April 2013. This has left patients having to travel to alternative hospitals almost 90 miles away or undergo more invasive forms of surgery.
None of the treatments listed above were universally available under the old system, when commissioning specialised services was the responsibility of primary care trusts, but had been in some areas.
One of the drivers for having nationally commissioned specialised services was to end variation in treatments available to patients living in different areas.
While there is widespread support for this principle, there are concerns that the new specialised commissioning structures makes decision making slow and the introduction of new innovations more difficult.
A senior figure from one affected trust told HSJ a “lack of pace” in planning specialised services meant patients were “not getting the kind of service they deserve”.
An executive director from another trust said in the past his organisation had a relationship with “people who could take decisions” about specialised services. He added: “Where we are now is commissioners have to refer innovations up the line to [NHS England headquarters] Quarry House and the desire to make sure there is one commissioning approach across the country is making it difficult to try new treatments.”
NHS England has introduced a programme called commissioning through evaluation where treatments that lack evidence of effectiveness due to a paucity of research would be commissioned on the grounds patients took part in clinical trials.
Selective Dorsal Rhizotomy for children with a high level of spasticity as a result of cerebral palsy was selected for the second phase on this programme along with three interventional cardiology procedures. However, almost two months after the closing date for bids from centres wishing to provide the service there has been no decision.
A spokeswoman for NHS England said it was evaluating the bids.
She said NHS England was “aware of frustrations from some clinicians and industry” and was providing assistance to navigate the new NHS England procedures.
“It is our duty to make sure the NHS resources are made available for the treatments that have demonstrated that they are clinically effective and cost effective. As a commissioner we need to ensure that the principles of determining whether an innovation has met those tests must be consistently applied.
“The result though of a national clinical commissioning policy is rapid roll out to the whole population never seen before in the history of the NHS. The process is subject to annual review and we are in the process of this year’s review.”