Arthroscopic shoulder decompression

As part of the ongoing review of clinical policies for all the NHS Clinical Commissioning Groups (CCGs) in Lancashire and South Cumbria, we are now seeking views and comments on the latest policy to be reviewed.

The latest draft clinical policy open for patient and public feedback is the new policy for  commissioning arthroscopic shoulder decompression (surgery) for subacromial pain (a common cause of shoulder pain and disability).

The draft policy can be found below.  You are invited to read the new clinical policy before giving your feedback. Your comments will be fed back to your CCG and the Commissioning Policy Development and Implementation Working Group, as part of the development process.

Futher down this page you will find some frequently asked questions which may answer any queries you have about the process or about this policy.

Comments on the arthroscopic shoulder decompression policy should be submitted by Friday 1 February. 

Arthroscopic shoulder decompression policy

Once you have read the new policy you can provide feedback through this online survey


If you have any further questions about this policy or the process being undertaken you can email or ring 01772 214244.

If you require any of these documents in an alternative format such as Braille, larger print, audio, British Sign Language or in a language other than English please contact the Customer Care Team in one of the following ways:

Further opportunities will be made available for your involvement and feedback on other clinical policies as and when they are developed and available for discussion.

Frequently asked questions 

These frequently asked questions are supplementary to the FAQ’s already identified as part of the clinical policy review process.

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 process.

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 CCGs.

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