NHS risking people"s health by rationing test strips, Diabetes UK says

The NHS is putting diabetic patients at risk of serious illness by rationing test strips that monitor blood glucose levelsin an attempt to save money, a charity claims. A survey carried out by Diabetes UK found that one in four complained of restrictions placed on the number of test strips they were prescribed by GP practices.

People with diabetes need to test their blood glucose regularly to monitor the condition. If not managed properly, diabetes can lead to health complications such as heart disease, strokes, blindness and amputations.

More than half of those professing problems had type 1 diabetes. Government guidance says this group should test themselves at least four times a day. Older people and those on low incomes were also affected, the charity found. Many said they felt they needed to buy test stripsonline, where quality cannot always be guaranteed.

People with diabetes were given a variety of reasons for the reduced number of strips prescribed, according to the charity. Some respondents to the survey said they had been told they should test less often. Some were told there were “budget constraints”, while others were told it was because they were testing too frequently.

“They said I had my allowance for the month,” said one respondent. Another said: “I was told they were expensive and we should test less. Only need to test four times a day. We use a pump, so need to test every two hours.”

Some said they were having to ask for repeat prescriptions more often. “I now need to order and collect a prescription monthly, or sooner, depending on any issues that crop up,” wrote one. Often when people complained to the practice, their normal prescription was reinstated. But Diabetes UK said they were concerned that people had to challenge the GP practice to get an essential piece of equipment.

Many clinical commissioning groups (CCGs), which have come under fire for rationing other NHS services, have guidance on how often people should test their blood glucose levels and how many boxes of strips should be issued each month. They have also urged GPs to switch patients to cheaper blood glucose meters and strips, sometimes against the patient’s wishes.

Diabetes UK said the rationing was a false economy because the cost of dealing with complications caused by poorly managed diabetes is far higher.

The findings came just weeks after Simon Stevens, the chief executive of NHS England, announced that the health service would stop prescribing some drugs and gluten-free foods to cut spiralling costs.

Diabetes UK’s policy manager, Nikki Joule, said: “These shortsighted cost savings cause people real anguish and potential financial distress. It also means people are struggling to manage their diabetes, which can lead to serious consequences for their health.”

Norman Lamb, the Liberal Democrats’ health spokesman, agreed. “This is more evidence of an insidious creeping retreat of the NHS without any public debate,” he said. “It makes no sense to undermine good preventive care in this way. More people will end up unnecessarily with their health deteriorating.”

It makes no sense to undermine good preventive care in this way

Norman Lamb, Lib Dem health spokesman

Testing strips are part of a kit used to check the condition. Diabetics prick their finger and put drops of blood on a strip, which then goes into a meter that measures blood glucose levels.

Dr Stephen Lawrence, clinical lead for diabetes for the Royal College of GPs, said: “£24m of the scarce NHS budget is spent on diabetes care every day, and it would be irresponsible not to make the most appropriate use of limited resources.”

He added that the need for strips varied between individuals and that doctors should sit down and discuss appropriate treatments with patients. “We urge NHS England to deliver on the pledges made in its GP Forward View for greater investment in general practice – including more GPs – so that we can give more time to all our patients, including those with diabetes,” Lawrence said.

The charity agreed that decisions on testing and access to strips should be made jointly between a patient and their GP. But their research suggested this did not always happen.

Colin Frampton, an 86-year-old pensioner with type 2 diabetes from Winchester, Hampshire, told Diabetes UK he was paying for test strips out of his pension after being restricted to 50 for the year – enough to test his blood glucose just once a week. He said: “If I didn’t challenge my GP, I’d still have to take money out of my pension to help me manage my condition.”

One pregnant woman, who is type 1 diabetic, saw her strips reduced from 300 to 50 a month, although the National Institute of Health and Clinical Excellence (Nice) guidelines suggest testing for pregnant women of 10 times a day or more.

The report also found that family doctors were overburdened and that receptionists and other surgery staff were increasingly preparing prescriptions. Some of these lacked the necessary understanding of diabetes. When a prescription was restricted, it was usually reinstated once challenged.

The charity said it was concerned that some people with type 2 diabetes who would have benefited from testing had been advised they did not need it, and called for a review of government guidance on this.

Professor Jonathan Valabhji, NHS England’s national clinical director for diabetes and obesity, said: “Ultimately, these are decisions for CCGs, but should be informed by best evidence and national guidance where appropriate. We need to ensure adequate provision and that clinicians take into account widely recognised Nice guidelines, which are clear about the need for test strips to support people in particular with type 1 diabetes.”

NHS risking people"s health by rationing test strips, Diabetes UK says

Charities call for NHS to stop rationing critical care

Theresa May has been urged by charity chiefs to stop the NHS rationing treatment for seriously ill patients and to find more money for their care in the budget next month.

About 30 health charities, including the Teenage Cancer Trust, National AIDS Trust and Motor Neurone Disease Association, have raised the alarm about NHS England “restricting and rationing treatment” because of underfunding, especially for patients with rare and complex conditions. The groups from the Specialised Healthcare Alliance said this rationing is taking place without sufficient public scrutiny. In a letter to the prime minister, they said NHS England is “choosing to restrict and ration treatments that patients with rare and complex conditions need – often without proper consultation with patients”. “We hope that you will take action to ensure full patient involvement in these decisions, and to ensure that any decision to ration treatment is overseen by democratically elected politicians,” they added.

The warning comes after health thinktank the King’s Fund said that politicians would be escaping culpability for rationing decisions, as plans due to come into force from April mean that even cost-effective treatments could be denied to patients.

Nicholas Timmins, a policy adviser at the organisation, wrote: “If the NHS can no longer fund new and cost-effective treatments, ministers should announce that decision case by case, and be held accountable for so doing”.

It emerged last month that cancer, diabetes and asthma patients could all be hit by the new affordability criteria, which means that drugs which cost the NHS more than £20m in total each year could be subject to restrictions.

The charity chiefs also raised wider concerns about funding for the NHS, which medics have said is under huge pressure this winter because of cuts to adult social care provided by councils.

Philip Hammond, the chancellor, is facing calls to give more money to the NHS next month after resisting an emergency bailout at the autumn statement. Instead, the government has launched a long-term review of social care and will allow councils to raise more through a local ‘precept’ (an extra charge to council tax bills which can only be used for adult social services) in the next couple of years.

No 10 and the Treasury appear to remain firmly against repeated calls from medics and the opposition for more cash for the NHS, indicating they are not prepared to change tack at the budget. But the charities say: “Our charities – and the patients we represent – are deeply concerned by the recent statements of Simon Stevens concerning the NHS’s relative underfunding. We urge you to ensure that this year’s budget provides the NHS with the funding it needs to deliver the standards of care patients expect.”

The charities issued their warning ahead of a Lords debate on the medical supplies bill this week, which Labour’s shadow health minister Lord Philip Hunt has described as a missed opportunity to “get rid of many of the restrictions on NHS patients using innovative new medicines”. A government spokesman said blanket restrictions on treatment are unacceptable and that the clinical needs of a patient, and the urgency with which they require treatment, must come first.

“The government is responding to the needs of the NHS by investing more money – £4bn this year – to fund its own plans for the future”.

Charities call for NHS to stop rationing critical care

PrEP rationing is symptomatic of NHS bid to cut costs, at all costs

NHS England’s setback in the high court over its attempt to get one set of cash-strapped public bodies (local councils) to foot the £10m-£20m a year bill for PrEP treatment rather than another – itself – is the latest manifestation of the health service’s increasing efforts to reduce the number of treatments it pays for, or the number of patients who receive them, or both.

Gradually, and largely unacknowledged, the NHS is rationing access to more and more types of care in order to try to balance its books, even when doing so includes treatments – such as PrEP, with its 90% success rate – that are proven to work but deemed prohibitively expensive in the midst of its decade-long funding squeeze.

Doctors, patients and health charities routinely insist that lives will be lost as a result, but still the process rolls on, affecting different groups of patients every time a decision is made.

HIV campaigners ‘delighted’ by high court ruling on preventative drug

Last week, NHS England was criticised by the charity Addaction for “abandoning” people with Hepatitis C, the blood-borne virus that can – if left untreated – cause severe liver problems, by decreeing that just 10,000 patients a year can receive drugs that studies show are effective in 90% of cases.

The 10,000-a-year quota was “manifestly unjust” and would mean “a potential death sentence for thousands”, claimed Simon Antrobus, the charity’s chief executive. About 214,000 in the UK are estimated to be infected with Hep C, and others have it without realising it. Many have contracted it from using needles and syringes to inject illegal drugs.

Addaction is waiting to hear if its application for a judicial review of the NHS’s introduction of quotas last year has been approved, so NHS England may yet have to defend the legality of its decision.

Coincidentally, the BMJ last week published the results of an investigation by academics at Cambridge and Bath universities into the restricted availability of drugs that cost about $ 90,000 per patient in the US and about £35,000 per head in England.

It found that, “NHS England, unable to budget for broad access to these drugs, tried to alter the outcome of the National Institute for Health and Clinical Excellence process [of approving them] and, when it failed, defied Nice’s authority by rationing access to them.”

Dr Andrew Ustianowski, an NHS consultant in infectious diseases who resigned from NHS England’s clinical advisory group in protest at its conduct, told the BMJ: “If you are going to choose a fight, then choosing this battlefield is quite a sensible thing to do – a marginalised population, very high-cost drugs.”

Related: Users of HIV prevention PrEP urge NHS to fund ‘life-changing’ medicine

Similarly, the Anthony Nolan Trust, aided by several dozen doctors, is campaigning to reverse NHS England’s recent decision to stop paying for a second stem cell transplant for people with relapsing blood cancer. Each such treatment gives the recipient a one in three chance of survival but costs between £50,000 and £120,00, which NHS England says is unaffordable. Nolan claims it has handed the 20 people a year who need a transplant but will no longer get one on the NHS “a death sentence”.

Until recently, most rows over NHS rationing have involved decisions by GP-led clinical commissioning groups, the 209 local NHS bodies that hold the health budget in different parts of England, to deny people who need it access to treatment including IVF, cataract surgery, hernia repairs and a new hip or knee.

But NHS England’s need to reduce the cost of what are known as specialised services, which jumped from £13bn in 2013-14 to £14.7bn last year, means it feels obliged to make what the Commons public accounts committee last month called “tough decisions”. It has already been attacked for reducing the number of drug treatments that the newly relaunched Cancer Drugs Fund will pay for from 84 in January 2015 to just 48 now and its budget from £466m to a strictly capped £340m.

NHS England’s actions cast doubt on its chief executive Simon Stevens’s public insistence that the extra £10bn a year ministers have said the NHS will receive by 2020 is enough for it to do its job properly.

With the NHS now desperate to prove it can live within its means, a further tightening of the rationing screw is inevitable, even though the human impact of an NHS struggling to live within its means will be measured in greater suffering, growing unmet medical need, reduced chances of survival, potentially higher costs in the long term, and more early death.

PrEP rationing is symptomatic of NHS bid to cut costs, at all costs

Rationing NHS care: why we require a serious debate | David Lock

‘We can never ever invest “enough” on the NHS simply because the a lot more we invest, the much more demand there will be for healthcare.’ Photograph: Christopher Furlong/Getty Pictures

The NHS is not investing our tax money properly. There is a broad professional consensus that as well much is being spent on hospital buildings it cannot afford, and it is failing to lessen investing on drug treatments that do not work. But many nearby NHS leaders are as well frightened to try and persuade the public of the situation for adjust. Reforms are delayed for dread of upsetting politicians who seek re-election.

Rationing healthcare treatment options to manage fees is regarded as an explosive problem in politics. In America, congresswoman Michelle Bachmann stated that the thought of therapy cost becoming taken into account, and at times withheld due to economic motives, would be a “horrific notion to our nation’s doctors”.

In contrast to this political rhetoric, in the law courts it is accepted that rationing is part of the healthcare enterprise. The supreme court of the United States accepted paying doctors to ration care, saying that there must be “some incentive connecting physician reward with treatment rationing”. In the United kingdom, the court of appeal has similarly held that it is lawful for the NHS to ration accessibility to healthcare. Political, not legal, constraints hold back NHS reform and the losers are vulnerable sufferers who do not get the remedy they need, whilst funds is wasted on hospitals that are not justifiable and solutions of marginal benefit.

Nigel Lawson observed that “the NHS is the closest factor the English have to a religion”. However, as with all religions, informed debate is clouded by myths. The very first is that the NHS does not have sufficient income. Investing on the NHS rose sevenfold in between 1949 and 2002 (making it possible for for inflation) and has continued to rise because then. We can in no way devote “ample” on the NHS due to the fact the far more we invest, the more demand there will be for healthcare.

Yet another misconception is that investing in the NHS is the best way to enhance the nation’s well being. This is untrue around 80% of deaths from the main ailments, this kind of as cancer, are attributable to lifestyle risk variables like smoking or a poor diet plan. Further spending on medical therapy for folks with preventable ailments is not an successful intervention. The third myth is that the NHS delivers most of its care in hospitals, when in fact 92% of care is carried out by GPs or in the local community.

These untrue but typically held beliefs have created it virtually not possible to have a wise discussion about what treatments ought to be funded, and how we must adjust the footprint of NHS buildings to get greater value for income. We have the Nationwide Institute for Wellness and Care Excellence in the United kingdom, and the US has the Patient Centred Outcomes Study Institute. But they are underfunded, dominated by supplier interests, and can only scratch the surface of the rationing debate.

This conversation is important but it are not able to occur unless individuals who make the choices locally invest much more time, energy and resources in educating the public about the alternatives that need to have to be created. Nearby NHS leaders need to shout loudly that not every cancer drug can be financed, not each and every small A&ampE unit should remain open, and a lot of local community hospitals are totally uneconomic. It is their job to counter the myths of objectors waving shrouds.

So far, the role of getting the “big undesirable wolf” who cuts A&ampE or maternity units has been left to faceless managers and the occasional brave public overall health medical professional. But the fiscal issues dealing with the NHS are now both huge and shut. There is an urgent need to have to move services into the community in buy to help the increasing elderly population. The overall health services desperately requires unprecedented amounts of structural modify.

Nearby commissioners have, by and huge, failed at genuine patient engagement, usually simply because it is an afterthought. The conventional NHS way is to make selections first and seek advice from the public afterwards. This is bad policy, and it leads to bad options. The public will only believe modify is necessary if they are trusted with all the data, the options are openly debated at an early stage, and they are repeatedly advised that we can only commit the money once. To give credit score the place it is due, NHS England is attempting challenging to lead debate but the true conversation requirements to happen at a neighborhood level. The job of GP commissioners is to be local community leaders for change. It implies dealing with the neighborhood press and difficult the vested interests, such as politicians, who are nicely-financed and will fight.

If this does not happen, elected politicians will oppose clinically needed change, and that will slow or avoid reform. The losers will be the frail elderly individuals who don’t get the providers they need, whilst massive amounts of money are becoming wasted elsewhere.

Barrister and former Labour get together politician David Lock will be delivering a lecture, Health rationing: how do legal and political constraints impede politicians taking required choices?, hosted by the Center for Transnational Legal Studies on 7 April

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Rationing NHS care: why we require a serious debate | David Lock

NHS sufferers "face much more remedy rationing considering that coalition restructuring"

GPs have said sufferers are encountering developing problems in acquiring care from community nurses, counselling, cataract surgery and fertility treatment Photograph: Dominic Lipinski/PA

Sufferers are dealing with developing rationing of remedies such as counselling, cataract removal and IVF since the coalition restructured the NHS final yr, GPs say.

In a survey of 315 family members medical doctors, GP magazine identified that 71% believed that restrictions on access to therapy in their area had elevated considering that April 2013, when the controversial shake-up of the NHS in England began.

That led to the creation of 211 GP-led clinical commissioning groups (CCGs), which control the spending budget for healthcare in an region and make a decision who can obtain what treatment. GPs mentioned sufferers have been encountering expanding issues in acquiring care from neighborhood nurses, counselling, cataract surgical procedure and fertility remedy. Rationing has improved drastically in the past nine months, medical professionals responding to the survey explained.

One particular loved ones physician, a spouse in a surgery, informed the magazine: “We have enormous expense pressures and this is resulting in increased rationing and fragmentation of solutions to reduce charges.”

Nevertheless, entry to excess weight-loss surgical treatment has enhanced, though sufferers can encounter what Dr David Haslam, a GP and chair of the National Weight problems Forum, called a “torturous” path to obtaining it. And some obese sufferers are expected to attend fat-loss programmes for at least a yr prior to they will be regarded as for surgical treatment.

Some CCGs aim to scrap rationing policies inherited from their predecessor major care trusts as soon as their finances are in the black. For illustration, six which have previously refused to offer you women IVF treatment method as suggested by the National Institute of Well being and Care Excellence hope to commence undertaking so.

Dr Richard Vautrey, deputy chairman of the British Health-related Association’s GPs committee, said that “many GPs are concerned about reduced engagement with community nursing teams and reduced or delayed accessibility to psychological companies, which is obtaining an affect on patient care.”

Andy Burnham, the shadow overall health secretary, said: “Labour has consistently warned that David Cameron’s re-organisation would consequence in a postcode lottery running riot via the NHS and this survey confirms that is exactly what is happening.”

A spokeswoman for NHS England denied patients were dealing with delays. “Well being support budgets have been protected and NHS England, by way of its mandate [from the Department of Well being], is guaranteeing that individuals acquire the companies they require in a timely manner”, she stated.

NHS sufferers "face much more remedy rationing considering that coalition restructuring"