What does this policy mean?
One of the possible treatments for snoring in adults involves surgery, by operations on the palate in the roof of the mouth. However, there is no clinical evidence that shows this is more effective than other, non-surgical treatments. This policy means that, throughout the NHS, surgery for this problem will not be routinely offered on the NHS. Other less harmful means of improving snoring are the only treatments that should be provided on a routine basis. The option for clinicians to submit an Individual Funding Request remains, should they feel a patient is an exception to this policy.
What treatments will be used instead of surgery to improve snoring?
There several alternatives to surgery that can improve the symptom of snoring.
• Weight loss
• Stopping smoking
• Reducing alcohol intake
• Medical treatment of nasal congestion (rhinitis)
• Mouth splints (to move the jaw forward when sleeping)
Why is the public engagement taking place now, just after the Christmas period?
NHS England has recently issued statutory guidance to NHS Clinical Commissioning Groups which requires them to have policies in place covering the treatments identified below, by April 2019. In order to meet this requirement and to ensure the policies are fit for purpose, public engagement needs to be undertaken in good time to accord with the official decision-making process.
NHS England has already undertaken a patient and public consultation on the criteria identified in these policies and there is not an opportunity, therefore, to change them further. Although NHS England is making the criteria for these treatments’ mandatory (as a minimum – CCGs can elect to go further), Clinical Commissioning Groups are still required to inform and involve patients and members of the public. A suitable period of public engagement needs to be undertaken, therefore, but it must allow CCGs to meet the obligations laid down by NHS England.
Public engagement will take place for a 3-week period, to be completed by the beginning of February (Friday 1 February).
Why are NHS England making these policies mandatory? Is this about saving money?
Both NHS England and the NHS Clinical Commissioning Groups are of the view that one of the main objectives of policies of this nature is to reduce avoidable harm to patients. With surgical procedures, there is always a risk of complications. In addition, professional staff time is wasted if unnecessary procedures are undertaken.
The staff time and resources saved by undertaking this procedure appropriately allows that time and resources to be used elsewhere within the local NHS. Any savings generated in this respect, therefore, are ploughed back into the service where it is needed. Inappropriate care is also poor value for money for the taxpayers who make the NHS possible.
Having consistent treatments decisions based on the latest evidence also helps health professionals keep up to date without removing their clinical discretion which forms part of their professional duties. At a time when demand far outweighs capacity, these decisions reflect the national and local priority of using resources effectively.
What will this mean to patients?
The policies being introduced guide the decisions made by CCGs about the procedures that will be made available to patients for these conditions. This is in both what the CCG will commission and in what Providers of services will be asked and paid to deliver. This has a direct impact upon which of these procedures patients and the public can expect to receive from their local NHS services.
Although some patients may no longer be eligible for these procedures, this is because the nonsurgical alternatives are safer, effective means of treating these conditions. Where a procedure is no longer routinely available on the NHS (as is the case with one of the policies/procedures below), patients can still have access to them if their GP/consultant believes they are an exception and will benefit from receiving it. This is called submitting an Individual Funding Request (IFR) and this option is always open to clinicians.
An individual funding request can be made by your clinician (GP or other health professional) if they believe that a particular treatment or service that is not routinely offered by the NHS is the best treatment for you, given your individual clinical circumstances.
When will these policies be adopted by the CCGs?
As part of the drive for introducing these policies at this time is the mandatory guidance from NHS England, the policies need to be in place for 1 April 2019. Public engagement will take place over a 3-week period following which the responses provided will be assessed. However, as this is mandatory, no change will be made the policy criteria. The policy will then need to be considered by the Commissioning Policy Development and Implementation Working Group, which is overseeing the policy review process, before final consideration by the Joint Committee of Clinical Commissioning Groups, which ratifies polices on behalf of all 8 CCGs.