The must-read stories and debate in health policy and leadership.

Staging an intervention

On many a policy issue, an apparently simple moral standpoint is often not quite what it seems.

So it is with treatments deemed of little or no worth when compared to the risk and cost involved which the NHS has decided it will no longer fund except in extreme circumstances; and where it is determined to radically drive down NHS activity.

If someone wants a lesion removed or trigger finger released, it may rightly not be a priority for NHS resource, but why can’t they pay for it out of their own pocket? And if they can, why shouldn’t NHS private units – which are after all already charging for ops including these ones and have for many decades – carry it out for them? (And they are, as we reported on Monday afternoon). Especially when trusts are under intense pressure to fill financial holes.

But, conversely, allowing this makes the NHS entirely complicit in this inequality of access based on ability to pay, and schemes where hospitals are very likely to link NHS restrictions into their own income generation and private unit marketing.

And, as Academy of Medical Royal Colleges chief executive Alastair Henderson commented on Tuesday on the story, if a treatment does not represent an evidence-based intervention for a patient, why should NHS trusts be offering them privately or otherwise?

This is the thinking of NHS England, along with the academy and other partners, who on Monday staged an intervention over these interventions, warning trusts to follow their earlier guidance and cease.

No easy answers. But it may come down to grey areas and realities of implementation.

Will medics or patients make sufficient inquiry as to whether or not a particular case is no-value, or should be one of the small number of exceptions? Will they apply the same standard of judgement? Will non-medical and non-physical factors – in a whole-person era – be given equal weight as crude clinical evidence? Will patients be equally pushy in seeking the op for free on the NHS, versus being sent off to put up with their complaint, or seek out the private option?

Hospitals need time to address teething problems when they deploy a new patient records system. That’s understandable. It’s a very tricky business.

But Mid Essex Hospital Services Trust has failed to report its elective waiting time data since December 2017 despite going live with Lorenzo over two years ago in May of that year.

Its main commissioner, Mid Essex Clinical Commissioning Group, seems to be at the end of its tether. 

Its 2018-19 annual report, discussed at its June board meeting, said the Lorenzo system had impacted on Mid Essex Hospital Services Trust’s “ability to produce accurate and timely data and… meet local and national reporting requirements”.

It added that: “[The issue] continues to adversely affect the CCG’s ability to effectively plan for activity and achieve NHS constitutional standards.”

The trust told HSJ it would be back on track with its referral to treatment data reporting later this year. It was holding weekly meetings with regulators and staff were receiving “refresher” training, it said.

And remember that Lorenzo is a system which the government has actively encouraged trusts to buy and offered extra cash to help their deployment. It’s high time these systems started delivering on the basics – at the very least.