Funding for some minor surgical procedures at Noble’s Hospital including tonsillectomy has been withdrawn as the NHS battles to cut costs.
Health Minister Kate Beecroft will ask Tynwald this month for extra funding to shore up an £11.1m overspend in her department.
That’s on top of the extra £9.943m agreed by Tynwald in June to cover a shortfall in the previous financial year.
Department of Health and Social Care chief executive Malcolm Couch has written to the island’s doctors, including GPs, about the suspension of some procedures deemed to have limited clinical value.
Many of the 33 procedures or treatments that have been suspended are ‘cosmetic’ and not routinely funded through the National Health Service such as tattoo removal, breast augmentation, liposuction and even face lift.
But others have been suspended while a review is carried out to determine the ‘clinical thresholds’ that will set out when a procedure is deemed medically necessary.
Procedures likely to be subject to a ‘threshold’ are tummy tucks, removal of adenoids at the back of the nose, breast reduction, circumcision, the insertion of grommets to help treat glue ear, the removal of tonsils and the surgical release of trigger finger.
Doctors have been advised no new referrals for these procedures should be made to the hospital during the review.
The DHSC said it has a duty to use its resources to provide services which deliver the ‘best outcomes possible’.
The letter to the doctors said a significant number of procedures were being carried which have a ‘limited or negligible effect’ on health outcomes, including quality of life.
Ramsey MHK and GP Dr Alex Allinson said: ‘I think this is designed to reduce unnecessary referrals rather than save money.
‘Most GPs would agree with the majority of the conditions on the list. However, there are some conditions where there needs to be a certain degree of flexibility and the ability to refer for a second opinion, especially if the patient asks for it, is very important. The tonsillectomy and circumcision inclusion are probably the most contentious as there are clear indications for them to be carried out.
‘A blanket ban on them is not good medicine and patients should be assessed on an individual basis.
‘As GPs we often see patients with recurrent sore throats who probably would benefit from having their tonsils removed. Similarly sometimes circumcisions are done for very valid medical reasons.’
The reasons for the £11.1m overspend are much the same as last year – the cost of locums and temporary staffing, rising prices of therapeutic drugs, tertiary care referrals to the UK and losses made by the government catering service.
Mrs Beecroft said: ‘Seeking approval from Tynwald for additional funding from the Treasury is not an action the department takes lightly. As Minister I take this matter seriously, especially as it is the second year in a row the department has sought approval for additional funding.
‘My highest priority will be to ensure that the department lives within the resources voted to it for 2017/18. The department must continue its drive to become more efficient. But if the books are to balance it is likely that hard and uncomfortable choices will need to be made.’
In October, Mrs Beecroft overturned a decision to refuse funding for life-transforming treatment for seven-year-old Finley Hesketh, who has Duchenne Muscular Dystrophy. Finley’s treatment with Translarna is expected to cost about £180,000 a year.
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Procedures likely to in future be subject to a ‘threshold’ are:
Abdominoplasty, known as a ‘tummy tuck’; Adenoidectomy (removal of adenoids at the back of the nose Breast reduction); Circumcision; Grommets to help treat glue ear; Tonsillectomy; Trigger finger – surgical release.
Procedures being reviewed include:
Alopecia; Benign skin lesion removal; Blepharoplasty and brow lift; Botulinum toxin for cosmetic indications or hyperhidrosis; Breast augmentation; Depilation; Ear lobe surgery; Face lift; Ganglion excision; Gynaecomastia – surgical correction; Labiaplasty, Lipoma removal; Liposuction; Nipple inversion correction; Penile implants; Pinnaplasty; Redundant skin removal, including thigh lift; Brachioplasty; Rhinophymal; Rhinoplasty; Scar removal; Skin resurfacing; Tattoo removal; Treatments for thread veins; Vaginoplasty; Viral warts