Ready, steady…. stop

This week, the NHS Alliance holds its annual conference, bringing together a legion of professionals working in primary care and the many people who want to speak to them. One group of professionals is likely to be particularly popular. GPs, who will soon be holding the NHS credit card, will not be short of networking opportunities.

Hip replacement: Photo - jilly andi via Flickr
Photo: Jilly Andi via Flickr

Given the expected budgetary pressures facing the NHS, the conference is perhaps unfortunately titled “The Cutting Edge”. This does, of course, focus the theme on innovation, but out in the real world we’ve started to see the clearest signs of PCTs starting to tighten their belts.

While there have been plenty of anecdotal reports of reductions in services and staff numbers, a second PCT has this week identified specific procedures and treatments it will no longer fund. The headline grabbing treatments would perhaps surprise some that the PCT ever funded them at all – the likes of tattoo removal or hair transplantation. It is debatable to what extent refusing to pay for the featured treatments would impact on a person’s overall health and capacity.

However, accompanying this list is a further set of procedures which are slightly more concerning. The first PCT that published such a list last month categorised a second tier of treatments as “Slow”, moving referral commitments to April next year. The second PCT more sensibly named an almost identical list “Steady” and promised to honour the 18 week referral time enshrined in the NHS Constitution. Just expect it to be the far end of 18 weeks.

Should any of the things on the Slow/Steady lists concern older people? It is difficult to say. Certainly they cover areas highly relevant to older people – routine elective hip, knee and shoulder surgery, for example. Cataract procedures following referral from an optician are also in there and older people are likely to represent the majority of people undergoing all of these procedures.

At the same time, there is a clear directive to deliver these interventions where there would otherwise be a significant impact on a person’s health. There is evidence, however, that health professionals’ perceptions of older people can impede referral at the best of times, so we have reason to be wary of decision-making around what are thought of as “low-priority procedures”.

It would be interesting to see if the PCTs in question have completed an equality impact assessment which includes age, though the duty to do so is not yet in place. We should not immediately make assumptions that older people will be unfairly affected by such de-prioritising – there’s every reason to believe this could free up time to treat older people with the highest needs.

However, the NHS does not have the best record of meeting the needs of older people, including prioritisation, and we watch any further announcements with interest.

There is a final point worth noting. With the NHS reforms extolling the virtues of local determination and meeting local needs, it is interesting to see that the lists of treatments from the two distant PCTs are identical, save for one example. Where best practice often struggles to spread, areas to cut may just go viral.

Age UK is hosting a fringe meeting at the NHS Alliance conference this Friday in the Tregonwell Seminar 1 Room  at 1.20pm: The big society: do we trust each other to deliver?

Author: Tom Gentry

Policy adviser - health services @tomogentry

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