Agenda item - Clinically Effective Commissioning (CEC): February 2018 Update

Brighton & Hove CCG will present an update on the Clinically Effective commissioning initiative (copy attached).

43.1    This item was introduced by Dr David Supple, Chair of Brighton & Hove CCG. Dr Supple explained that the Clinically Effective Commissioning (CEC) initiative will help STP area CCGs align policies and best practice: for example, by ensuring a consistent approach to tonsillectomies which reflects national guidance. For Brighton & Hove most policies have not changed, and nothing is being withdrawn at this stage, although the threshold to access some procedures may change.

CEC will also help ensure that the NHS only funds effective treatments – e.g. it is questionable whether patients who undergo a knee arthroscopy, and then shortly afterwards need a knee replacement, have received any benefit from the arthroscopy.

CEC has been arranged in three tranches. The first two traches have been agreed, but no decisions have yet been taken about the third tranche (which deliberately includes the most potentially controversial/emotive issues), and no engagement on these procedures has been undertaken to date.

43.2    In response to a question from Cllr Deane on how wellbeing rather than just health outcomes were factored in to CEC evaluations, Dr Supple said that this was an interesting point which he would take back to the CCG.

43.3    In response to a question on the CEC tranches from Cllr Morris, Dr Supple told members that tranche 1 consisted of ‘easy wins’ where there was a virtual clinical consensus already; tranche 2 of procedures where there was potentially some ambiguity in the NICE guidelines; and tranche 3 of procedures recognised as emotive areas. The CCGs are well aware that short term savings may have negative long term consequences, and are committed to looking at quality of life for patients rather than crude thresholds of efficacy.

43.4    In answer to a question from Cllr Morris on the inclusion of IVF in tranche 3, Dr Supple explained that there are varying clinical opinions about the thresholds for NHS IVF: for example, in terms of age (the effectiveness of IVF declines markedly at later ages), and the number of cycles that should be on offer. Other CCGs have dramatically reduced the availability of IVF treatments.

43.5    In response to a question from Colin Vincent on cataracts, Dr Supple responded that it may be useful to look at whether it makes sense to automatically book patients in to have both cataracts dealt with when there is some evidence that many patients are happy with just having one cataract removed.

43.6    Dr Supple agreed to come back to a later HOSC meeting to report on the outcome of the evaluation of tranche 3 procedures. He also pointed out that further discussions around thresholds and even availability might be required depending upon CCG finances.

43.7    RESOLVED – that the report be noted.