When you visit your doctor with a common condition that is treatable using a tried and tested procedure recommended by national clinical guidelines, you’d expect to be offered it. You’d also expect a family member who lives nearby to be offered the same treatment.

Sadly, that’s not always the case.

Say, for example, you live in Barking. You have a cataract that has deteriorated to the point where your vision is becoming impaired and you’re worried about falling and getting injured. The National Institute for Health and Care Excellence (NICE) guidelines say that, because it affects your quality of life, the cataract should be surgically removed.

You’re in luck! Barking & Dagenham Clinical Commissioning Group (CCG) would normally commission the treatment for you.

Your cousin in Basildon may not be so fortunate though. Basildon and Brentwood CCG includes cataract surgery on its list of restricted procedures, known as Procedures of Limited Clinical Value (PoLCV), and applies a higher threshold to treatment.

Every CCG in the country has a PoLCV list. They are usually buried deep on the CCG’s website where only the very determined will venture and are usually reserved for complementary therapies or cosmetic procedures that are not proven to have any clinical benefit or are simply just not cost-effective. You’ll find procedures such as homeopathy, tattoo-removal, and breast reduction on them for example.

All over the country, CCGs are using these lists to restrict patient access to proven treatment. We found that over half of CCGs restrict access to cataract surgery, even though NICE says it has ‘a high success rate’ and is cost effective. Just under half limit hernia repair, often taking a ‘watchful waiting’ approach that can lead to more emergency cases. 78 CCGs include hip and knee replacements on their list of restricted treatments, even though they’ve been used for over half a century. Twelve CCGs refuse to provide patients with continuous glucose monitoring, and a further seven insist on a special application called an Individual Funding Request.

These lists are widely criticised. The Royal National Institute for Blind People has described the restrictions on cataract surgery as ‘shocking’. The Royal College of Surgeons says that: ‘denying [these treatments] ultimately endangers the lives of patients and the standard of treatment available in the NHS’.

The Medical Technology Group has long campaigned for wider access to proven treatment for patients, based on their needs, not their postcode. That’s why we’re launching Ration Watch, a campaign to highlight variation in local commissioning and call for changes to eradicate the postcode lottery.

We want NHS England to set clear guidelines on which procedures should be commissioned and which should not. We want a national body to be created with the power to intervene when unfair policies are adopted.

Above all, we want CCGs to look beyond the immediate cost of procedures and recognise the benefit that many offer in improved patient quality of life, reduced long term costs, and reduced welfare bills.

For more information visit our Ration Watch campaign website.

March 2019

NB Our analysis of CCGs PoLCV lists was undertaken in October/November 2018. Some CCGs may have amended their policies since.