Difficult Decisions – Stakeholder Briefing

The six Clinical Commissioning Groups (CCGs) in Staffordshire and Stoke-on-Trent want the views of the patients across the area as they plan services for the future.

Altogether the six CCGs commission over 800 different services and treatments, but the availability of these varies across the area.

Together they have been spending around £2 million more per week than they receive, and that means some difficult decisions now need to be made.

That is why they are now asking people for their experiences of five different treatments for which access is different across Staffordshire and Stoke-on-Trent. The CCGs want to understand the real impact these treatments have on people’s lives before deciding how they should be provided across Staffordshire and Stoke-on-Trent in the future.

Surveys will be available to complete online from Monday, January 6 until Sunday, March 1. Paper versions will also be available upon request.

Dr Lorna Clarson, a GP and Clinical Director for Partnerships and Engagement, said: “We want the treatments that we commission for our patients to be those that clinical research shows are most effective. We also want to end the postcode lottery that currently exists and offer the same services to patients regardless of where they live within Staffordshire and Stoke-on-Trent.

“Effective treatment for life-threatening conditions such as cancer will always be a top priority. We also feel it is important to take early action before conditions become more serious and that mental ill-health is just as important as physical ill-health.

“But prioritising some treatments will mean that others may only be made available if certain criteria are met and that some procedures will not be routinely available to all patients. We are now seeking views on some of the treatments that are already restricted or not routinely available across different parts of Staffordshire and Stoke-on-Trent.”

The five areas are:

Assisted conception

Last year a total of 216 cycles of IVF (the most common form of assisted conception) were completed. The level of service differs depending on where in Staffordshire or Stoke-on-Trent people live, with differences including the age range in which patients are eligible to receive IVF, and the number of cycles that will be funded.

Hearing loss in adults

Where hearing loss cannot be treated with medication or surgery, hearing aids are the most common treatment. Patients in North Staffordshire do not currently automatically qualify for hearing aids if their hearing loss is mild or moderate. South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group Cannock Chase Clinical Commissioning Group East Staffordshire Clinical Commissioning Group North Staffordshire Clinical Commissioning Group

Removal of excess skin following significant weight loss

There are various surgical methods of removing excess skin following weight loss. Demand is expected to rise because of the increase in the number who need to lose weight, with provision varying widely.

Breast augmentation and reconstruction

All the CCGs fund reconstructive surgery following a mastectomy carried out due to suspected or proven cancer. However, there are a number of other reasons why breast surgery may be carried out and availability of NHS funding for these varies across the area.

Male and female sterilisation

There are a number of different procedures that can be carried out which amount to a permanent form of contraception. There are currently no restrictions in place on NHS funding for these operations across Staffordshire and Stoke-on-Trent, despite a lack of research evidence about the long-term benefits for patients.

Dr Clarson said: “We have a Clinical Prioritisation Advisory Group (CPAG) to consider which procedures have been proven to be effective and which groups of patients have been shown to get the most benefit from them. This group is made up of clinicians who review all clinical trials and research studies relating to a particular treatment or test.

“But is also important that we listen to the view of patients to understand the impact these treatments have on their lives so we are asking the public to take part in a survey to help us do this. The surveys are available on the CCGs’ websites between Monday 6 January 2020 and Sunday 1 March 2020, and people can complete a survey for one or as many of the five conditions as they would like to. We will also be holding a number of local face-to-face events and we will announce details of these shortly.

“We would like to reassure people that no decisions have been made and the results of the surveys they complete will be independently analysed. This will help us create a shortlist of viable options for access to these treatments across Staffordshire and Stoke-on-Trent, following which a formal consultation will then be held to gather feedback on these options.”

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