NHS targets suncream prescriptions for cuts

Suncream, cold remedies and gluten-free food may no longer be available on the NHS in England under a crackdown on “low value” medicines.

NHS England announced a review after local health bosses identified £400m of spending they believe has little or no clinical value.

It also includes some types of pain relief and travel vaccines.

The proposals could see an outright ban or tighter restrictions on some products being prescribed by GPs.

An initial list of 10 products has been drawn up by NHS Clinical Commissioners, which represents local health managers who are in charge of budgets.

A number of them are available over-the-counter at a lower price than the cost to the NHS of prescribing them or include drugs for which there are more effective or cheaper alternatives.

Evidence submitted to NHS England – and seen by the BBC – argues that the prescribing of gluten-free products dates back to the 1960s when there was not the choice there is now in supermarkets and shops.

Cutting back on prescriptions for the 10 products could save the NHS over £100m a year.

While patients can be charged for prescriptions, the wide range of exemptions mean only one in 10 items handed out are paid for by individuals.
‘Low value’ medicines on the list and their annual cost to the NHS:

£30.93m on Liothyronine to treat underactive thyroid
£21.88m on gluten-free foods
£17.58m on Lidocaine plasters for treating nerve-related pain
£10.51m on Tadalafil, an alternative to Viagra
£10.13m on Fentanyl, a drug to treat pain in terminally ill patients
£8.32m on the painkiller Co-proxamol
£9.47m on travel vaccines
£7.12m on Doxazosin MR, a drug for high blood pressure
£6.43m on rubs and ointments
£5.65m on omega 3 and fish oils

Source: NHS Clinical Commissioners

NHS Clinical Commissioners has also highlighted other products which it wants reviewed once the initial batch of 10 have.

This includes suncream, cough and cold remedies and indigestion and heartburn medicines, which could bring the saving to £400m a year.

That is out of a total bill of over £16bn on medicines once those dispensed by both hospitals and GPs are taken into account.

NHS Clinical Commissioners chief executive Julie Wood said “difficult choices” had to be made given the unprecedented financial and demand challenges facing the NHS.

She said it was important to reduce spending on prescription items that have “little or no clinical value”.

NHS England confirmed the review would begin in April, but did not put any timescale on how quickly a decision would be made.

The news comes ahead of a major announcement by NHS England later this week on the future of the health service.

Suncream, cold remedies and gluten-free food may no longer be available on the NHS in England under a crackdown on "low value" medicines.

Number of long waiting hospital operations rise by 163%

The number of people facing “long waits” for hospital treatment in England has more than doubled in the past four years, figures show.

The number of people facing "long waits" for hospital treatment in England has more than doubled in the past four years, figures show.

Patients needing routine care such as knee and hip replacements are meant to be treated in 18 weeks under NHS rules.

But the numbers waiting longer than that now top 350,000 – a 163% rise since 2012. There are 3.7 million people in total on the waiting list.

The government promised the NHS would do “better in the future”.

Scotland, Wales and Northern Ireland have also seen pressures grow – meaning no part of the UK is now meeting its target to see patients.

Royal College of Surgeons president Clare Marx said the picture was “very disappointing” as these operations and treatments could make a huge difference to people’s lives.

“Someone waiting for a gall-stone removal will be in a lot of pain and discomfort. The longer you wait for a hip or knee replacement the less likely you are to have good outcomes. These waits really matter. The standards of care are being eroded and we don’t want it to get worse.”

But Richard Murray, from the King’s Fund think tank, predicts the numbers on the waiting list will keep rising.

The total of 3.7m is a 44% increase since 2012, but he expects to see the trend continue and break through the four million barrier by the spring.

The latest figures cover the month of November and mean the target for the NHS – that at least 92% of patients on waiting lists will not have been waiting over 18 weeks – has been missed since February last year.

A Department of Health spokesman said the NHS was having to treat more patients – 5,000 extra a day compared with 2010 – so the levels of performance were actually a “tribute” to the work of NHS staff.

He said the investment being made in the NHS this Parliament would help “transform services” and mean the NHS will do “better in the future”.

The targets for routine treatments are measured differently in Wales, Scotland and Northern Ireland, but all show a similar picture.

In Wales, 95% of patients are supposed to start treatment within 26 weeks. This target has not been met since August 2010 and the number of long waiters has risen by 74% to 60,643 in November 2016.

Scotland’s target is for 90% of patients to start treatment within 18 weeks. This has been missed since June 2014. The number waiting longer than 18 weeks was up 82% over that period at 16,635.

Northern Ireland has a target of 55% per cent of patients waiting no more than 13 weeks for an operation. The number waiting longer than that was up 95% in the four years to September 2016.

Calls for tougher smoking and junk food rules in hospitals

There are calls for more to be done to stop people smoking at hospitals and promote healthy living.

There are calls for more to be done to stop people smoking at hospitals and promote healthy living.

Health boards say they are powerless to enforce smoking bans on their grounds as they are not yet backed up by law.

BMA Cymru said a decision had to be made on whether hospitals were “places of health or not” as smoking areas could still be allowed in future.

The Welsh Government said the Public Health Wales Bill would help make the Welsh NHS an “exemplar” to follow.

The National Obesity Forum has also called for a blanket ban on the selling of junk food to patients, visitors and staff, saying hospitals should be “role models” for healthy living.

If introduced, the bill currently under consideration by the assembly for the second time, would make it illegal to smoke on hospital grounds in Wales.

But a clause in the draft legislation – which has faced some criticism for containing no specific measures to tackle obesity – would give hospital managers the power to create designated smoking areas if they chose.

But Dr Phil Banfield said there should be no exceptions to the rule anywhere on hospital grounds, as the sites needed to promote healthy lifestyles.

“There is a conception that hospitals are places of healing,” he said. “Having an activity that is the leading cause of death and hospital admissions on the doorstep seems a contradiction.”

Mr Banfield said most people smoked while they are waiting in hospitals or visiting ill relatives “because they are bored” and more had to be offered as an alternative distraction at all times of the day and night.

He added that people should be offered help to quit smoking while they are in the hospital grounds – with access to support at any time, on the same footing as drug addicts.

“Hospitals need to be more inventive about how we promote the wider issues for the community,” he said.

“We are very rigid in the way we run our hospitals, really we have to think about them as community assets – our hospitals belong to the people.”
Image caption Public Health Wales Bill measures on the table

Since 2008 health boards have been barred from stocking vending machines with unhealthy snacks – such as crisps and fizzy drinks – following Welsh Government guidance.

Despite the rules stressing only food with “positive nutritional benefit” should be sold, some health boards appear to be ignoring the advice.

Cwm Taf health board said all six of its hospitals had vending machines containing canned drinks and sweets, while Abertawe Bro Morgannwg hospitals have 34 machines selling fizzy drinks, according to a Freedom of Information (FOI) request by the Welsh Conservatives.

The BMA has previously called for hospital food standards to be made law rather than guidance as part of the Public Health Wales Bill, but has warned some areas to tackling the problem are outside the assembly’s control.

Tam Fry, of the National Obesity Forum, said: “A hospital is a place people go to be cured, if we therefore do not have healthy food and behaviours in the hospital for the patients, visitors and staff, then we are selling short of what is required.

“You have barely walked through the door and there are places selling and promoting sugary food and drink, it is soul destroying for the people that work there, who are trying to free people from disease. The people that are buying this stuff are probably going to be treated by them, if not now, then in the future.”

A spokeswoman said that the new health bill would build on voluntary smoking bans and new hospitals were being focused on the “patient environment and journey” with courtyards and breakout spaces.

“We want people to be able to access health services in a modern, fit for purpose environment. “Many of our hospital buildings have access to coffee shops and other facilities run by a range of organisations which provide access for visitors and patients.”