John Kell
Head of Policy

NHS England has put forward plans to limit the use of some interventions – often surgery – that it considers poor value for money, ineffective, or even in one or two cases unsafe. They will still be available to some patients, but only in certain, well-defined circumstances.

This is the third initiative along these lines, following new guidance on ‘low value’ medicines and over-the-counter medicines. As with these earlier guidelines, while we acknowledge the need to ensure NHS funds are spent wisely, we are concerned that the end result will be to shut some patients off from treatments that would be beneficial.

Before we wrote our response, we conducted a survey to see what patients think about measures of this sort. The results make for extremely interesting reading – thank you to everyone who responded. While there is certainly a wide variety of views among patients, it’s clear that there is not widespread support for restricting access to treatments in this way – and in particular, patients are concerned about a ‘rolling programme’, as NHS England proposes.

We have therefore recommended that NHS England should take any decision about ‘low value’ treatments alongside all its other decision-making about how to spend the additional funding it was awarded this summer. These proposals were devised before the new money was announced, and it seems to make little sense to make these decisions in isolation from the wider round of prioritisation that is being undertaken as part of the development of the Ten Year Plan for the NHS.

We have three reasons for recommending that NHS England reconsiders its plans. Firstly, they are high risk. It is inevitable that some patients will be denied treatment they would benefit from, and will suffer harm as a result. Our survey found that when patients are on the wrong end of rationing decisions, the most common result is not for things to be put right, but for the patient to go without and potentially suffer harm. Introducing new barriers, even if they look fair on paper, and patients who really need a treatment should still get it, will only result in mistakes, inconsistencies and confusion, and patients missing out as the net result.

Secondly, we feel that the current proposals cover too many treatments. The first step should be for NHS England to show proof of concept with a smaller range of treatments, and evaluate the work thoroughly to show that patients are not coming to harm as a result. Instead, the current approach to evaluation is focused primarily on financial savings.

And thirdly, it’s clear that there is not support for these proposals among patients. Our survey found a big split of views between patients who would like to see extra funding for the NHS to cover all new treatments, and those who agree that some older treatments may need to be withdrawn to free up resources for newer ones. But there was general unhappiness at a ‘rolling programme’ to make these changes, and little confidence in NHS England to make the decisions in this area.

The survey will be published in full in a separate report, but the bulk of its findings can be found in our consultation response.

Separately, we are holding a workshop on this subject for NHS England on 15 October in Birmingham. If you would like to share your views directly with NHS England, you can register your interest by emailing Anna Shears.