The Savage Reality Of Cost-Cutting For Chronic Pain Patients

Today's post from theguardian.com (see link below) is a UK post providing an alarming foretaste of what may be to come in many other countries, in these days of cuts to health services and cuts in support for chronic pain patients. We all know that cuts are happening across the world, in a vague and on-going response to the financial crisis of 2008 and nowhere are those cuts deeper than in the health systems of individual countries. Faceless bureaucrats are desperately searching for corner-cutting savings within their own systems and the first things they aim for are what they call 'fringe benefits' to patients suffering a wide range of illnesses. Therefore, if the medication or treatment is not directly saving lives, or worse, not likely to raise much opposition because they are only relevant to smaller patient groups, they make easy targets. Many of the cuts listed here are directly relevant to neuropathy patients. You may well say that this is a UK problem and that other countries would either never provide these free of charge anyway, or would never cut them because they are of proven benefit to patients (it all depends on how rich your health budgets are) but the fact is that slowly but surely, savage cuts are being made and it will only get worse. If your only aim is to balance a budget then you don't care if small groups of patients are adversely affected. This is what happens when civil servants take over health systems and they are thrown open to market forces. So many neuropathy patients depend on their gluten-free diets, or Lidocaine patches, or many other creams, supplements etc because they know from personal experience how much their symptoms are reduced. Unfortunately, it's the way of the world at the moment. All you can do is protest but it may not do you much good - you're a file number on a computer and you're budgeted for: the fact that your health is on the line is of little interest to the accountants. God help us if we ever want medical marijuana added to our 'subsidised' list. The problem is that cutting these subsidies means increased health costs further down the line, as patients' conditions worsen and they need more expensive treatment but that never enters the equation. It's a hard world and it's getting harder.

GPs to stop prescribing omega-3 oils, gluten-free food and cough medicine
Denis Campbell , Matthew Weaver and Haroon Siddique Tuesday 28 March 2017 08.33 BST First published on Tuesday 28 March 2017 00.59 BST
 
NHS also removes medication for upset stomachs, haemorrhoids and erectile dysfunction from list of prescribed items

Gluten-free food will be on the banned list.
 
The NHS is to stop giving patients travel vaccinations, gluten-free foods and some drugs that can be bought over the counter in an attempt to rescue its ailing finances.

Simon Stevens, the chief executive of NHS England, announced the changes in an interview with the Daily Mail in which he detailed new efforts to get better value for money so that money saved could instead be spent on promising therapies that have recently been developed.

NHS services face 'impossible' budget crisis, health trusts warn


 GPs will be told to not prescribe medications such as those for upset stomachs, travel sickness and haemorrhoids in the drive to eliminate waste from the NHS’s £120bn annual budget.

Stevens said: “We’ve got to tackle some of the waste which is still in the system. The NHS is a very efficient health service but like every country’s health service there is inefficiency and waste.

“There’s £114m being spent on medicine for upset tummies, haemorrhoids, travel sickness, indigestion, [and] and that’s before you get to the £22m-plus on gluten-free that you can also now get at Morrisons, Lidl or Tescos.

“Part of what we are trying to do is make sure that we make enough headroom to spend money on innovative new drugs by not wasting it on these kind of items.”

Next month, NHS England will start reviewing 10 items that it says are “ineffective, unnecessary [and] inappropriate for prescription on the NHS, or indeed unsafe”, which together cost the service £128m a year. The Department of Health is expected to then issue new guidance advising GPs that they are not prescribed.

They include omega 3 and fish oils; the painkiller fentanyl: lidocaine medicated plasters; a tablet used to treat high blood pressure called doxazosin MR; and a drug called tadalafil, which is used to treat erectile dysfunction, along with gluten-free foods and travel vaccines.

NHS Clinical Commissioners, which represents England’s 209 NHS clinical commissioning groups (CCGs) – the GP-led bodies that hold health budgets locally – has asked NHS England to look into whether the 10 items are a good use of scarce cash when the NHS is undergoing the tightest budgetary squeeze in its 69-year history.

Many other common medications could soon be added to the banned list. NHS England said: “In light of the financial challenges faced by the NHS, further work will consider other medicines which are of relatively low clinical value or priority or are readily available over the counter and in some instances, at far lower cost, such as treatment for coughs and colds, antihistamines, indigestion and heartburn medication and suncream. Guidance will support clinical commissioning groups in making decisions locally about what is prescribed on the NHS.”

Frontline doctors said the idea should help the NHS to prioritise spending but they called for safeguards to protect vulnerable groups.

Prof Helen Stokes-Lampard, the chair of the Royal College of General Practitioners, said: “We do welcome these proposals but cautiously. I think a blanket ban might well introduce some unfair problems.”

Speaking to BBC Radio 4’s Today programme, she added: “The difficulty is when people don’t pay prescription charges, so they are entitled to free medication on the NHS, and that’s when they’ll be difficult conversations. GPs don’t want to be rationing. It is time that country needs these difficult conversations but we mustn’t put at risk the health of the vulnerable.”

Dr Amanda Doyle, the NHS Clinical Commissioners co-chair, said: “The NHS is in quite constrained financial circumstances and what we are trying to do is prioritise our spend. We are currently spending hundreds of millions of pounds on things we would generally consider to be low priority for funding and we are looking at ways of reducing that spending so we can direct the funding in to things that take a higher priority.”

Are you affected by the NHS stopping gluten-free prescriptions?

But Norman Lamb, the Liberal Democrats’ shadow health secretary, said: “This creeping retreat of the NHS should not be happening without a national discussion about how we can afford a modern, efficient and effective health and care system. We do have to confront tough choices about whether we all pay more or whether the NHS does less but the public should be part of that discussion. And the bottom line is that this is intended to save £1bn over two years when we face a shortfall of over £10bn by 2020. This does not solve the massive problem we face.”

NHS bosses hope the moves could ultimately save as much as £400m a year. The service is facing serious financial problems. NHS trusts in England recorded a deficit of £2.45bn last year and are expected to end this financial year almost £1bn in the red again, despite repeated warnings to get their finances in order.

An NHS spokesman said: “New guidelines will advise CCGs on the commissioning of medicines generally assessed as low priority and will provide support to clinical commissioning groups, prescribers and dispensers.

“The increasing demand for prescriptions for medication that can be bought over the counter at relatively low cost, often for self-limiting or minor conditions, underlines the need for all healthcare professionals to work even closer with patients to ensure the best possible value from NHS resources, whilst eliminating wastage and improving patient outcomes.”

Stevens’ money-saving initiative is a foretaste of a major initiative he will unveil on Friday. He will announce details of his long-awaited “delivery plan” to fulfil his pledge, first made in October 2014 in his Five Year Forward View modernisation blueprint, to radically transform how the health service works by 2020 so that it delivers better care and closes the £22bn gap that is expected to open up in its own finances by then in order to remain sustainable.

He will give the go-ahead to between six and 10 of the 44 sustainability and transformation plans (STP), one covering each part of England, which are intended to implement his ideas, which centre on moving a lot of care out of hospitals and treating patients closer to home and keeping them healthier so that they avoid expensive £400-a-night unnecessary stays in hospital.

Read more The STP plans have proved very controversial because they could see dozens of hospitals lose key services, such as their A&E or maternity unit.


The 10 items under review (and cost to NHS) are as follows:

• Liothyronine, used to treat underactive thyroid £30.9m

• Gluten-free foods £21.9m

• Lidocaine plasters, for reducing nerve-pain £17.6m

• Tadalafil, for erectile dysfunction £10.5m

• Fentanyl, used for terminally ill patients, including those with cancer £10.1m

• Co-proxamol, painkiller, £8.3m

• Travel vaccines £9.5m

• Doxazosin, for high blood pressure, £7.1m

• Rubs and ointments £6.4m

• Omega 3 and fish oils £5.7m

Clinical Commissioning Groups have also suggested savings could be made on other products, including the following*:

• Hayfever remedies £37m

• Indigestion/heartburn remedies £27m

• Suncream £1.4m

• Cold and cough remedies £1.2m

* Figures taken from NHS Digital’s Prescription Cost Analysis England 2015.

https://www.theguardian.com/society/2017/mar/28/nhs-draws-up-list-of-items-to-be-banned-from-prescriptions