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Packed meeting calls for NHS rationing rethink
16 Aug 2017 18:20 #3159

Basil Clarke Basil Clarke's Avatar Topic Author

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aebm meeting at beaumont august 2017b150 people turned out for Tuesday's meeting at the Beaumont - you had to be early to get a seatEnfield residents at a meeting this week called on NHS commissioners in the borough to withdraw proposed new restrictions on the provision of knee replacements, hearing aids, breast reconstruction, hernia operations and several other medical procedures.  Speakers at the meeting queried the "evidence base" for the proposals and expressed the view that the cumulative "deficit" run up by Enfield Clinical Commissioning Group (CCG), amounting to £34 million, was not the result of overspending but of underfunding. The meeting also heard about Enfield Council's plans to save money by reducing support payments to some people in need of care at home, particularly those needing night-time support, who stand to lose around £26 per week.

In a resolution passed almost unanimously by around 150 attendees (there were no votes against and one abstention), the meeting called on Enfield Clinical Commissioning Group to withdraw its proposals to bring in stricter criteria for treatment based on "Adherence to Evidence Based Medicine".  The resolution called for the CCG to instead work with local people to reduce health inequalities in the borough and to support the cross-party Fair Funding for Enfield campaign.

hands off our hearing aids

Hands off our hearing aids

At the meeting two representatives of Action on Hearing Loss (you might know it better under its old name of RNID) spoke about their campaign to defend the provision of hearing aids on the NHS.

13 CCGs in various parts of England have proposed cutting back on the provision of hearing aids for people suffering mild or moderate hearing loss.  After intervention by Action for Hearing Loss only one CCG went ahead.

Action for Hearing Aid was able to convince CCGs that their proposals were based on a seriies of misconceptions, eg that hearing aids provided no benefits, that there are no national guidelines and that mild hearing loss sufferers don't want hearing aids.  They went on to work with the CCGs to make efficiencies in other ways.

Read what Action on Hearing Loss thinks about Enfield CCGs proposals

"An insult to the clinical judgement of GPs"

Introducing the meeting, Vivien Giladi, Enfield Over 50s Forum's Health Lead, said that the proposals - "cuts masquerading as a good thing" - represented a "real and present danger" to patients throughout north central London.  They threatened the prospect of more people being in more pain for longer. Evidence-based medicine is what all doctors practise and always have done and the proposals were an "insult to the clinical judgement" of GPs, at the very time when Enfield is already suffering from a serious shortage of GPs and with too few new doctors being trained.

For Over 50s Forum Chair Monty Meth, Tuesday's meeting, held at the Beaumont Care Home in Southgate, was the most important in the Forum's 18-year history. The "draconian" measures planned by the CCG, which would predominantly affect older people, were a dishonest method of solving its budgetary crisis. NHS England, by imposing "special measures" on Enfield CCG, had put it in a "financial straitjacket".  Instead of responding by making dishonest claims about the NHS carrying out unnecessary procedures, the CCG ought, he said, to be campaigning for more funding.

Monty Meth pointed out the inadequacies of the consultation document.  There was no cost/benefit analysis, not even an estimate of how much the savings would be, and an impact assessment had not been carried out, to determine whether or not the changes would affect some groups of people more than others.  He claimed that no doctors would endorse the proposals.  At the four consultation meetings held earlier this year not a single voice from the public was raised in favour of the plans.  The response to the AEBM consultation had been unprecedented in its size.  So many replies had been received that the CCG had been forced to pay an outside company to assess them, at a cost of £7,800.

bambos charalambous at aebm meeting aug 2017aBambos Charalambous raises a smile - one of the few lighter moments at the meeting"Suspend the AEBM process"

Another speaker at the meeting was Deborah Fowler, the outgoing Chair of Healthwatch Enfield.  The role of Healthwatch bodies throughout England is to ensure that the voices of NHS patients are listened to.  In June Healthwatch Enfield wrote to the CCG summarising the almost unanimously negative public responses to the AEBM consultation, asking the CCG to suspend the AEBM process and give due consideration to these responses.  The letter also criticised the CCG for failing to carry out an equalities impact assessment.

On the other hand, Deborah Fowler said that the need to make savings would not go away, and she pointed out that there were some medical conditions where, for purely clinical reasons, surgery was no longer considered the optimum treatment - club foot was an example.


In the view of Southgate MP Bambos Charalambous, Enfield CCG had carried out a "figleaf" consultation.  The initial 30-day deadline had been extended only because of protests, the comparisons with Clinical Commmissioning Groups elsewhere in the country had been flawed and the consultation questionnaire format was such that it would not produce meaningful responses.

Challenged by Enfield Green Party member Jean Robertson-Molloy about the possibility of a "progressive alliance" in Parliament to fight the rundown and privatisation of the NHS, Bambos Charalambous said that in the present circumstances MPs of various parties, including the Conservatives, were able to work together to influence government policies.

The MP pledged that he and the other Enfield members - Kate Osamor (Edmonton) and Joan Ryan (Enfield North) - would hold Enfield CCG to account, and he expressed the view that to solve underfunding of the NHS taxation was the way forward.


The view that the key to the financial woes of Enfield CCG and of the wider NHS was not overspending, but insufficient government funding, was a common theme, and those agreeing with this included a member of the CCG's governing body, Rathai Thevananth, who was attending the meeting in order to help gauge public feeling about the AEBM proposals.

Some statistics to confirm the level of underfunding and the affordability of increased NHS spending were provided by Jeff Lever of Defend Enfield NHS. He quoted international studies showing the NHS as the most cost-effective among the developed countries, though in recent times the UK had been slipping down the league table for patient outcomes.  In terms of health spending as a proportion of gross domestic product, England was significantly behind two comparable countries, France and Germany.

Jeff Lever also highlighted the implications of the government's intention to implement the Naylor Report, which recommended selling off large amounts of NHS-owned real estate.  This was condemned as a short-term measure, similar to earlier disposals of publicly owned assets which former prime minister Harold Macmillan had criticised as "selling off the family's Georgian silver".

Jean Brewer, South West Enfield Localities Champion for the Patient Participation Groups Network, thought that NHS administration had become too complex and bureaucratic - it was like having jigsaw pieces scattered all over the floor. Sue Davies of Defend Enfield NHS warned against any increased funding being swallowed up as extra profit by private companies and supported campaigning against privatisation of the NHS.

What can be done?

Monty Meth noted that the Over 50s Forum had celebrated some notable victories in previous campaigns.  His suggestions for resisting the AEBM cuts were:

  • Spread awareness by telling two friends about what was happening
  • Speak to your GP and try to get them involved
  • Join your surgery's Patient Participation Group
  • Lobby the Governing Body of Enfield CCG before their meeting on 20th September and ask questions at the start of the meeting (12.30pm at Holbrook House, Cockfosters - Monty suggested gathering there from 11.30am)
  • Lobby the CCG Governing Body at its annual general meeting on 27th September


Action on Hearing Loss

Enfield Carers Centre - information about proposed changes to disability benefit calculations

Enfield Over 50s Forum

Defend Enfield NHS

Enfield CCG Governing Body meeting (open to the public - the venue is the Dugdale Centre, not Holbrook House)

Enfield CCG Government Body annual general meeting (open to the public)

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Packed meeting calls for NHS rationing rethink
17 Aug 2017 20:20 #3161

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The original venue information for the CCG Governing Body meeting was, after all, correct - Holbrook House, Cockfosters Road (near Cockfosters Station). However, the room there is small, so there's still a chance that the venue might change - watch this space.

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"Evidence-based" NHS cuts are undermining doctors' professional judgement
22 Aug 2017 23:56 #3166

Basil Clarke Basil Clarke's Avatar Topic Author

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Enfield CCG have not tried very hard to hide the main reason for these "Adherence to Evidence-Based Medicine" proposals - cost-cutting. Which is not to deny that there are valid clinical, as well as financial reasons, why doctors should consider less drastic measures first before resorting to surgery. However, I believe that judgements should be made by GPs, patients and hospital specialists, not by a CCG panel that has not examined the patient and is essentially conducting a box ticking exercise.

There was a very interesting programme on Radio 4 tonight www.bbc.co.uk/programmes/b091v271 about "overdiagnosis" and "overtreatment". Contributors were sceptical about scanning apparently healthy people for incipient disease and about the financial incentives that were introduced by the government in 2004 which encourage doctors in England (they have been abandoned in Scotland) to obsess with measuring blood pressure, cholesterol etc and then incentivising them to prescribe particular drugs.

The presenter, Dr Margaret McCartney, clearly shares the view that overdiagnosis and overtreatment are a real issue. For one thing, they leave GPs too little time to deal with patients as individuals. However, she finished the programme by condemning CCGs for using this fact as an excuse for cuts. It was quite clear that what she was talking about was exactly the sort of exercise being carried out by Enfield CCG under the guise of "AEBM".

We're also in a time of cuts to NHS budgets, and some clinical commissioning groups are appropriating the language of overdiagnosis campaigns as a cover for cost-cutting. This is just as bad. Financial incentives not to treat are no better than financial incentives to prescribe more drugs.

And this is at the heart of this debate: What price professionalism? For each individual patient there will be a different set of priorities. We need to remove financial inducements that can bias doctors one way or another, to restore professionalism as the basis of clinical judgement and to develop genuine shared decision-making between doctor and patient.

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