Choosing Wisely Engagement Event 8th August 2017
Address: Harrow Baptist Church, College Rd, Harrow HA1 1BA
Date: 8 August 2017
NHS North West London recently engaged with stakeholders around three proposals to change the way we prescribe in the boroughs of Brent, Ealing, Hammersmith & Fulham, Harrow, Hillingdon, Hounslow, Kensington & Chelsea and Westminster. An equality impact assessment was undertaken by independent provider Public Health Action Support Team (PHAST) as part of the process. This validation session will examine the EQIA report and its recommendations to ensure they accurately reflect the feedback contributed during the Choosing Wisely engagement process. Interested stakeholders and members of the public are welcome to attend. More details about the proposals are available at https://www.healthiernorthwestlondon.nhs.uk/news/2017/06/12/choosing-wisely-changing-way-we-prescribe. Please RSVP firstname.lastname@example.org and advise if you have any accessibility requests.
Last Friday saw a wave of key announcements from NHS England, from how major plans to transform local services are progressing, right down to how well the NHS is supporting people with sensory impairments and learning disabilities to access information about health and care. However, the one that hit the headlines was about plans to cut certain prescriptions that the NHS considers to be ineffective or, because they are low cost, believes patients should simply go out and buy. National Voices criticised the plan saying that it would break with the guiding principle that the NHS should be free at the point of use. Likewise, the Royal Pharmaceutical Society raised concerns about how the move might affect the poorest families.
Yet our research shows people recognise the huge pressure the NHS is under at the moment, that they are open to things changing and they want to do their bit to help. This may well include revisiting how prescriptions for certain treatments should work. But let’s be clear, this is not a conversation about whether or not homeopathic remedies should be available on the NHS, as many of the newspaper headlines suggested. As NHS England themselves outline, this alone would save just over £100k a year, a tiny proportion of the £190 million proposed and a drop in the ocean when compared with the other NHS efficiency targets.
In this initial round, there is a list of 18 specific treatments up for discussion, but this will set the framework for future decisions so it is vital that the NHS gets this right.What is needed is a sensible discussion about national policy that puts the evidence clearly on the table, actively engages those directly affected and helps to avoid another wave of postcode lotteries on top of those that are already causing confusion. Part of the problem is the merging of two issues in one consultation. On the one hand, we have medication in the current list that has been found to be ineffective or even dangerous. There is likely to be little argument about stopping this. Likewise, there are examples where there are cheaper alternatives, where most people would expect the NHS to take the prudent financial decision to switch.
However, the broader question is about whether or not things like sun cream should be covered by the NHS. On the surface this seems simple, but not for those with serious skin conditions that need such products on a daily basis. It’s also worth noting that creams for eczema and non-contact dermatitis are on the same list. For these people, paying for regular treatments out of their own pockets simply may not be possible. The NHS needs to avoid presenting this as a technical issue because, whilst it might seem that like at the top, on the ground, it is a very different story. Take the conversation around gluten free foods. Whilst this has been consulted on separately by the Department of Health, it is being lumped in with the wider point about what should and shouldn’t be made available on prescription.
NHS England says that there are a range of gluten free products available in high street supermarkets and that people can easily avoid gluten by eating things like ‘rice cakes’. Similar words were not very comforting for 18th Century French peasants and neither are they likely to bring much relief for parents living on the bread line – no pun intended – trying desperately to get a child with coeliac disease to eat. The consultation is now live and will be running until Thursday 21 October. Local Healthwatch will be out doing their bit and helping as many people as possible to have their say, but it is vital that NHS England takes the consultation activities beyond merely publishing the document on its website and suggesting that clinical commissioning groups can undertake local engagement activities to inform their own responses. For a decision of this nature, there is a practical need as well as a moral obligation for NHS England to set out clearly how it plans to evaluate the impact of any final decision on the communities affected.
There are relatively few figures in the consultation document to help people understand how many people would no longer be able to access each or all of the treatments identified as suitable for people to buy over the counter, or on the scale of the prescribing bill for those items. I hope NHS England and local commissioners will seek to shed more light on this early enough for people to have a real say in response.
Have your say
Do you have views on what medicines can be considered a low priority for NHS funding? Share your views on NHS England's proposals by Thursday 21 October.