Issue - meetings

14.1     The Committee considered a report providing an update on Clinically Effective Commissioning.

14.2     Ashley Scarff, Deputy Chief Officer and Director of Strategy, High Weald Lewes Havens Clinical Commissioning Group (HWLH CCG); and Dr Shivam Natarajan MS FRCS, Clinical Lead from Clarity Consulting, answered questions from the Committee.

Reason for reviewing procedures with limited clinical effectiveness

1.1.        Dr Shivam Natarajan explained that there are approximately 2,500 hip and knee operations in the STP area per year. Out of those, 150 were for revisions of previous operations which means that they were either not done appropriately or properly.

1.2.        An initial knee operation costs £5-10k but a revision costs £110k. The Clinically Effective Commissioning (CEC) programme is looking at the first point in the surgical pathway at which these unnecessary revisions can be prevented, which is to ensure that the policies of all CCGs in the STP area are clear about who the appropriate people are who should receive the surgery and when the appropriate time is in the clinical pathway for them to receive it. This has two benefits: appropriately giving the right person the knee operation will avoid the unnecessary expense of complications, and by having the right people have the surgery additional people who do require the surgery can receive it in a timely manner.

1.3.        Dr Natarajan explained that the appropriate thresholds for patients to receive each type of surgery will be set out in STP-wide policies that are in line with the Royal College guidelines and clinical best practice, for example, the current policies for a hysterectomy differ across each CCG, with some saying patients may have one after six months of conservative management and others after 12 months. However, the clinical evidence says there should be three stages/ types of conservative management that should be tried if possible before major surgery. The policy being developed, therefore, says that patients should go through three stages of conservative management before going to surgery. Changing the eligibility for surgery to fit with clinical best practice is not a purely financial exercise but in the interest of good patient care; and may result in more surgeries for some CCGs, or a greater number of surgical procedures for some illnesses.

1.4.        Dr Natarajan added that Clinically Effective Commissioning will also tie into other clinical work such as Get it Right First Time and the STP’s acute care workstream by highlighting the various avoidable variations in care and eliminating waste. Within the STP only half the surgeons involved with hip and knee replacements are carrying out 30 or more knee or hip operations per year the remaining half are only doing a handful. This variation in quality that this causes should be avoided and is something that could be addressed through this other work, for example, agreeing as part of the acute care workstream to do knee operations in only three major centres of excellence. Ashley Scarff clarified that this process would not result in a limitation in choice but balance  ...  view the full minutes text for item 14