What is meant by arthroscopic shoulder decompression for subacromial pain?
Shoulder pain is a common symptom for which there are a variety of causes. One of
these is the condition called shoulder impingement. In this condition, a bursa (which
is a fluid filled pad that lies around the rotator cuff tendons of the shoulder) becomes
inflamed. As the bursa also sits under the acromion bone (the bony arch at the top
edge of the shoulder), when the arm is lifted, the bursa becomes trapped and
pinched (the acromion bone impinges upon the bursa), causing pain. Therefore, it is
referred to as subacromial pain.
Decompression is a clinical term for a type of surgery (surgery is undertaken to
release the pressure caused by the acromion bone on the bursa/fluid filled pad).
This condition can impact not only upon the wellbeing of the individual patient but
also on their capacity to carry out daily tasks and to work.
Why do we need a policy on the treatment of arthroscopic shoulder decompression for subacromial pain?
There are two main reasons why we need a policy.
Firstly, as mentioned above, arthroscopic shoulder decompression is surgery.
Surgery carries a risk of complications and may harm the patient more than it helps.
Where there are less risky treatments or procedures available that are proven to
work in many or most cases, then these should be used first
For subacromial pain non-operative treatments such as physiotherapy, exercise
programmes, medication, rest and steroid injections can all be used and can be
effective in treating the condition. Decompression/surgery should be used therefore,
as a last resort.
Having a policy ensures that only those patients who require surgery are the ones
who receive it and unnecessary harm and risk are avoided. It also ensures the
treatment is delivered fairly and equitably across the region.
The second, and more pressing reason why a policy is needed now, is that NHS
England has recently issued statutory guidance to NHS Clinical Commissioning
Groups that they need a policy in place for this treatment/procedure by April 2019.
As two of the CCGs in Lancashire and South Cumbria already have a policy
covering this procedure, it has become necessary to ensure this policy is developed
across the other 6 CCGs in the region, in keeping with the policy harmonisation
Why is the public engagement taking place over the Christmas period?
Reference was made above to the requirement from NHS England to have a policy
in place by April 2019. In order to follow the agreed robust policy development
process and to ensure it reaches the appropriate decision-making bodies within the
region, a suitable period of public engagement needs to be undertaken that allows
us to meet the obligation laid down by NHS England. In order to do this, public
engagement needs to commence as soon as possible.
Public engagement will take place for a 4-week period, commencing in the New Year
and will continue until the end of January.
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. As mentioned earlier, 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.
When will this policy be adopted by the CCGs?
As part of the drive for introducing this policy at this time is the mandatory guidance
from NHS England, the policy needs to be in place for 1 April 2019. Public
engagement will take place over a 4-week period following which there may be
changes made to the policy. 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