NHS medical director Professor Sir Bruce Keogh has warned that commissioners must not bring in “outright bans” on treatments or interventions.

In a letter, dated 21 September and seen by HSJ, Sir Bruce wrote to strategic health authority medical directors saying there had been “press and parliamentary interest” in commissioners restricting access to treatment.

He said the “unprecedented financial challenge” facing the NHS was expected to lead to “reasonable policies and procedures regarding referrals… with a view to ensuring as full a range of services as possible can be provided for the whole population”. However, he said: “We have always been clear that this cannot and should not be interpreted as permitting the introduction of blanket bans…”

He asked that the message be “cascaded” by SHA medical directors to their primary care trust counterparts.

Some PCTs have published lists of treatments – thought to be of low clinical value – which will not be funded in attempts to reduce activity. An Audit Commission briefing in April said restricted treatments have included those thought to be ineffective, cosmetic interventions, those with “a close benefit or risk balance” and costly procedures where alternatives should be tried first.

Sir Bruce said: “Any decision to restrict access to a treatment or intervention must be justified in relation to a patient’s individual circumstances, and any individual affected must be able to challenge such decisions through an exceptional cases review process.”

He said decisions “should not be made solely on the basis of cost” and processes must be in place locally for decisions to be “adequately defended” against legal challenges. Commissioners should have “robust policies in place which can support clear and defensible decisions on whether access to services will or will not be possible,” he said.

Sir Bruce added that the QIPP Right Care team would be working with SHA medical directors to “co-ordinate discussions between the royal colleges, the specialist surgical associations and commissioning bodies” on the issue.