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

Postcode lottery

The postcode lottery has reared its head again, with a new report revealing widespread restrictions on basic elective surgeries. 

The Medical Technology Group – the alliance of charities and medical technology providers which carried out the research – discovered almost one in five clinical commissioning groups restricted access to at least three of four basic treatments: cataract surgery, hip and knee replacements, continuous glucose monitors for people with diabetes, and hernia repairs. The vast majority – 88 per cent – of CCGs limited access to at least one.

But a penny saved now by such limitations may lead to several pounds spent by the NHS further down the line. The budget impact of falls caused by poor eyesight and diabetic complications from poor glucose control are just two examples. 

As with most cases of funding restrictions, NHS Clinical Commissioners has said the problem is caused by limited resources and “spiralling demands”, but that doesn’t explain why some CCGs appear to be better at commissioning for their population than others.

The Royal College of Surgeons said the issue should be resolved by “an unambiguous message from government that restricting such treatment is wrong”, but this is likely to mean little to the CCGs which claim they are being assigned budgets that do not stretch to buy all the services they need to provide.

Proof of the pudding

Accusations from senior managers that the targets review is being used to try and divert attention away from poor performance rather than develop clinically-optimal standards are unlikely to abate any time soon.

There is no doubt an appetite to review the four-hour standard, which has been in place (albeit with a 98 per cent target until 2010) since 2004, and consider alternatives which better align with the significantly different patient pathways within the system 15 years on.

But HSJ is yet to hear from a local hospital chief who would be happy to scrap the four-hour target and impose the new metrics set out in the NHS England review published this month. 

On Wednesday, we reported the following concerns:

  • One senior provider sector executive said: “There is a sense that, yes, we need to look at clinical standards, but that there is probably a pre-determined answer [already decided by NHSE]. It’s probably 60 per cent about taking the focus away from performance, and 40 per cent that we need a good look at these clinical standards because they have been in place for a long time and we need to make sure they are right.”
  • A trust chief executive said: “I think we’re getting rid of [the four-hour target] because it can’t be met any more.”
  • Another acute provider chief said: “My trust can’t meet the standard anymore, mainly [because of] workforce issues. That doesn’t mean abandon the standard – it means, let’s focus on workforce.”

NHSE rejects this, instead insisting it was following a process and no final decisions have been made yet.

The proof of the pudding will, of course, be in the eating.