Hertfordshire NHS service changes – decisions announced
A special joint committee of representatives from Herts Valleys Clinical Commissioning Group and East and North Hertfordshire Clinical Commissioning Group yesterday announced a number of decisions about NHS services in the county.
The decisions, made at a three-hour meeting held in public, follow a 10-week public consultation on a series of proposals designed to make best use of the money and resources available to the local NHS and encourage people to live healthier lives, avoiding preventable illnesses. All proposals were debated in full and members of the public had the opportunity to make representations in front of the committee.
The changes are:
- ‘Morbidly obese’ patients with a BMI of over 40 will not be referred for routine surgery until they reduce their weight by at least 15% over 9 months or reduce their BMI to less than 40 (whichever is the greater weight loss). ‘Obese’ patients starting out with a BMI of over 30 will not be referred for routine surgery until they reduce their weight by 10% over 9 months or reduce their BMI to less than 30. These criteria will apply unless waiting for surgery would be more harmful.
- Smokers will be required to quit smoking before being referred for non‐urgent surgery, unless waiting for surgery would be more harmful for them.
- Gluten- free food will no longer be available on prescription, with the exception of those patients with learning disabilities or where there are welfare concerns.
- In future, people wanting a prescription for medicines, products and food items that are available to buy from pharmacies, supermarkets or shops for short-term conditions will need to purchase them directly, except in exceptional circumstances.
- Female sterilisation will only be funded in exceptional circumstances, which would be assessed on a case‐by‐case basis if alternative forms of long‐acting contraception are unsuitable.
- IVF and other specialist fertility treatments will no longer be funded, except in exceptional circumstances. This decision will be reviewed after one year, in the light of the financial position Herts Valleys finds itself in at that time.
- A proposal to stop funding for vasectomies was rejected on the basis that this would not be cost-effective when the long-term cost of contraceptive services is taken into account.
During an extensive public engagement campaign - which included big public meetings, drop-in discussion events, press and social media – thousands of online and postal responses were received from members of the public, special interest groups, clinicians, local wellbeing groups and providers of services. The vast majority of the proposals received considerable public support.
Dr Nicolas Small, Chair of Herts Valleys CCG said:
“None of these decisions have been taken lightly, but people understand that the NHS faces major challenges and must adapt to meet them. There is wide public backing for most of the changes that have been agreed today – even from people who told us that they would be directly affected.
“As we plan the implementation of today’s decisions over the months ahead, we will make sure that everyone who needs to make lifestyle changes, including those who need to lose weight or quit smoking, gets the information and support they need to succeed.
“Although we are asking people to take more responsibility for some aspects of their healthcare where possible, we won’t be withdrawing any support from people who are not able to do this. GPs will still make decisions based on the individual needs of their patients, and will be able to refer individual cases to a specialist decision-making panel if their patient faces exceptional clinical circumstances.
“Proposals on IVF services in particular generated strong feelings and it was an especially difficult decision. We have listened to the views of local people and I am pleased that we decided to review today’s decision in 12 months’ time in the context of our future financial position.
“On behalf of our board I do want to thank all the residents in this area who took the time and trouble to give feedback on our proposals over the last few months. We learned a lot from the conversations we had and appreciate the effort people have put in to tell us what they think.”
The changes will be implemented over the coming weeks and months, along with a public information campaign about the changes.
The consultation proposals, responses received during the consultation and decisions made are as follows:
Fitness for non-urgent surgery
Morbidly obese patients with a BMI over 40 would need to reduce their weight by at least 15% over 9 months or reduce their BMI to less than 40 (whichever is greater) before having non‐urgent surgery.
Agree – 85%
Disagree – 15%
Obese patients with a BMI over 30 will not get non‐urgent surgery until they reduce their weight by 10% over 9 months or reduce their BMI to less than 30 (whichever is the greater).
Agree – 73%
Disagree – 27%
Smokers would be required to quit smoking before being referred for non‐urgent surgery, unless waiting for surgery would be more harmful for them.
Agree – 85%
Disagree – 15%
Gluten-free food on prescription
Gluten-free food should not be available on prescription, with the exception of coeliac patients with learning disabilities or where there are safeguarding concerns.
Agree – 77%
Disagree – 23%
Over-the-counter treatments, products and food
Limit the prescribing of medicines, products and food items that are available without a prescription from a high‐street pharmacy, registered online pharmacy, supermarket or shop for short-term self-limiting conditions
Exclusions to this policy would include:
- Where there are safeguarding concerns.
- patients with long term conditions, for example osteoarthritis and the need for regular pain relief.
Agree – 89%
Disagree – 11%
Female sterilisation would only be funded in exceptional circumstances, which would be assessed on a case‐by‐case basis if alternative forms of long‐acting contraception are unsuitable.
Agree – 62%
Vasectomy (N.B. Herts Valleys CCG area only)
Vasectomies will take place in community locations such as clinics or surgeries rather than in a hospital. (This is in line with provision in other parts of Hertfordshire). GPs will consider individual circumstances before recommending procedures.
Agree – 55%
IVF and specialist fertility treatment
Recognising the emergency measures the CCG is taking, with respect to its finances - with immediate effect, no longer fund IVF and other specialist fertility treatments, except in exceptional circumstances.
An agreement to review this policy in 12 months.
Patients who met the criteria for referral to IVF and specialist fertility services during the period from 16 June to 12 October 2017, but who were not referred for treatment because of the ‘pause’ in services for people living in the Herts Valleys area, will be eligible for one cycle of IVF in line with the CCG policy. For a referral for treatment to go ahead, all investigations would need to have been completed and the CCG IVF eligibility criteria met, during the time of the pause. Patients will have access to one cycle of IVF if they would have been referred for IVF during the period outlined above, if it hadn’t been for the pause in services.
We will soon provide further details of the process patients need to follow. Please check back on this website for more information and next steps
Link to eligibility criteria:Fertility treatment and referral criteria for tertiary level assisted conception
Public views – Herts Valleys CCG area:
- Continue to fund one cycle – 70%
- Stop funding, except in exceptional circumstances – 21%
- Stop funding altogether – 10%
NHS East and North Hertfordshire and NHS Herts Valleys Clinical Commissioning Groups (CCGs) are led by local doctors representing the needs of their patients and the views of their GP colleagues, as well as by lay members of the local community.
They are responsible for planning, designing and buying health services for Hertfordshire’s residents and monitoring the quality and effectiveness of those services.