Tribunals urged after study finds ‘unacceptable’ variations in healthcare access

By Ella Pickover15th August 2017News EnglandCare Standards, Commissioning, Hospitals, Long Term Care / Conditions, News England, NHS, Pay and Conditions

Local health bodies should have to face a tribunal board if they have “overly restrictive commissioning policies”, a new report suggests.

The recommendation comes after researchers found that there is “unacceptable” variation in access to care for patients across England.

After examining data concerning each of the 209 clinical commissioning groups (CCGs) across England in relation to certain treatments, researchers highlighted a number of variations in access to care and waiting times including:

Less than one patient (0.173) per 100,000 population in Southampton was referred for a computed tomography colonoscopy – a diagnostic tool for bowel cancer – compared with nearly 59 patients per 100,000 in Fareham and Gosport.
The authors found vast differences in the rate of stroke patients being admitted to a specialist unit with four hours of arrival at hospital – from 84.5% in Hillingdon to 21% in Wyre Forest.
In some regions, there were 207 hip replacements being performed for every 100,000 people living in that area, but in others the rate was just 54 per 100,000 population.
In urology and ophthalmology, the worst performing CCGs only hit the 18 referral to treatment time target about 80% of the time, the authors said. This means that one in every five patients from those regions get treatment in the required time frame.

The authors said that NHS England should establish a tribunal board to consider whether individual CCGs have overly restrictive commissioning policies which are contrary to national guidelines.

The report, by the Medical Technology Group (MTG) – a collaboration of pharmaceutical companies, patient groups, research charities and medical device manufacturers – also examined whether CCGs were falling behind on waiting times for patients.

After examining referral to treatment times, researchers created league tables for CCGs for waiting times for a number of medical treatments such as pacemakers, cataract surgery, and hip and knee replacements.

They found that seven of the 10 “worst performers” at hitting the 18-week referral-to-treatment time target were actually rated as good or outstanding by NHS England.

The authors said: “CCGs currently go through an Ofsted-style assessment programme.

“Each CCG is given one of four ratings: inadequate, requires improvement, good, or outstanding.

“The MTG does not believe that these ratings are sufficient to give patients an overview of how their CCG is performing.

“The key factors for patients are gaining access to treatment and successful, quick recoveries. It is not clear from the current rating system that there is sufficient weighting given to these aspects of care.”

The authors suggested that performance against the 18-week wait should have a stronger impact on each CCGs’ ‘Headline Rating’.

Barbara Harpham, MTG chairwoman, said: “Delivering high-quality healthcare, no matter where you live, is one of the fundamental principles of the NHS. But budget cuts and rationing is having a huge impact on the service patients receive, and the outcome they can expect.

“There is an unprecedented strain on the health service and patients are not being given equal access to the treatment – and most importantly – the technology they need.”

An NHS England spokeswoman said: “Although this report by companies seeking to sell products to the NHS is largely a rehash of old and previously published data, the NHS RightCare programme is helping local areas identify which treatment differences are linked to local need, and which aren’t.

“But as the Academy of Medical Royal Colleges has pointed out through its Choosing Wisely initiative, over-treatment is often as much of an issue as under-treatment.”