You Said, We Did

On this page you will find information and updates on the consultations and engagement work we have carried out.

Consultations

The future of the Birmingham and Solihull Clinical Commissioning Groups (CCGs)

During July and August of 2017, NHS Birmingham CrossCity CCG, in partnership with NHS Birmingham South Central CCG and NHS Solihull CCG, ran a consultation on the future of the NHS Birmingham and Solihull Clinical Commissioning Groups.

Overall, the majority of consultation responses were in support of a full merger of the three CCGs. A full merger was progressed with the new CCG to cover Birmingham and Solihull to begin 1 April 2018.

Mental health recovery and employment services

From March to May 2017, NHS Birmingham CrossCity CCG, in partnership with NHS Birmingham South Central CCG and NHS Sandwell and West Birmingham CCG we ran a consultation on changes to mental health day services..

We have now considered all of the feedback and would like to share how we have incorporated it into our plans.

Non-emergency patient transport (NEPT)

During the summer of 2015, in partnership with NHS Birmingham South Central CCG, NHS Solihull CCG and NHS Sandwell and West Birmingham CCG, we ran a consultation about creating one universal service for all patients across Birmingham, Solihull and Sandwell.

Following the consultation and the procurement process West Midlands Ambulance Service NHS Foundation Trust will be providing a new non-emergency patient transport service from 1 May 2017.

Engagement

Harmonised Treatment Policies

Following on from new treatment policies published in 20016/17, in July 2017 the Birmingham and Solihull CCGs began working with clinicians and key stakeholders to discuss and assess the evidence and current guidance relating to 22 further treatments and procedures. As a result, draft policies have been created in the areas listed below.

The table shows the treatment or procedure, details of the proposed changes and an opportunity for you to read the full policy as well as a patient-friendly leaflet. 

We have completed an engagement exercise to listen and understand the thoughts and views on the proposed new harmonised treatment policies with members of the public, patients and key stakeholder groups. This was completed by carrying out an online survey and we held a number of engagement events across the local area between 14 May and 22 June 2018.

We would like to thank everyone who has taken the time to share their views. We are currently in the process of evaluating all the feedback and a final report will be published in the near future.

Area/procedure  Definition New draft policy summary Proposed change Rationale for change

Knee arthroscopy for degenerative knee disease

Arthroscopic knee surgery is a treatment which may include:

• Arthroscopic lavage (also called ‘arthroscopic washout’),

• Arthroscopic debridement (in combination with lavage) and

• Arthroscopic partial meniscectomy (APM) which may be performed singly or in combination with debridement and lavage.

Knee arthroscopy for degenerative knee disease is not routinely commissioned

See full policy for more details.

We propose to limit the availability of knee arthroscopy for degenerative knee disease to those conditions and individuals where this intervention is likely to be of benefit, in line with latest evidence. 

The procedure will not be undertaken for diagnostic purposes, for knee “washout”, or for treatment of osteoarthritis, other than for patients with documented history of knee locking.

Clinical evidence strongly demonstrates that knee arthroscopy in degenerative knee disease causes increased damage to the knee and reduces the life of that knee. Any improvement in pain and mobility from arthroscopic knee surgery is often short-lived.

See draft patient leaflet.

 Hip arthroscopy

The three surgical approaches commonly used are:

• Open dislocation surgery involving dislocation of the hip joint

• Arthroscopy (a surgical procedure that allows doctors to view the hip joint without making a large incision (cut) through the skin and other soft tissues) or

• Arthroscopy with a limited open approach.

To limit the availability of this procedure to provider trusts able to:

· Fully support the patient with an experienced Multi-Disciplinary Team.

· Provide genuine choice of more limited surgical incision where clinically appropriate.

See full policy for more details.

Limit the provider trusts performing this procedure to ensure that patients are receiving the best possible care in a supportive multi-disciplinary team environment.

Patient safety and best clinical outcomes.

See draft patient leaflet.

Surgery for carpal tunnel compression

Common condition that causes a tingling sensation, numbness and sometimes pain in the hand and fingers.

Patients must have a definitive diagnosis of carpal tunnel disease and have failed conservative treatment.

See full policyfor more details.

No change from previous policy To be approved by the new Birmingham and Solihull CCG Governing Body

N/A.

See draft patient leaflet.

Dupuytren’s contracture

A condition that affects the hands and fingers, often causes one or more fingers to bend into the palm of the hand.

Treatment options have been broadened to include collagenase injections as well as surgery for patients with moderate disease and joint contracture of at least 30 degrees.

Percutaneous needle fasciotomy (PNF) is no longer routinely commissioned as a treatment option.

See full policyfor more details.

Inclusion of collagenase as a less invasive treatment option for patients.

Percutaneous needle fasciotomy (PNF) is no longer considered an effective treatment for patients by NICE (2017).

NICE TA 459 2017

See draft patient leaflet.

Assisted Conception

Treatment for patients diagnosed with infertility.

One fresh cycle of IVF for patients who meet the eligibility criteria.

See full policy for more details.

For patients who previously fell under the commissioning responsibility of Birmingham CrossCity CCG, the upper eligibility age for women diagnosed with infertility who are clinically suitable for IVF has changed from 42 to under 40 years old. Birmingham South Central and Solihull upper age eligibility for women remains unaltered.

Clinical evidence review demonstrates that a fresh cycle of IVF in the 40-42 year old patient group has a significant reduction in producing a live birth.

See draft patient leaflet.

Gamete retrieval and cryopreservation

Treatment to retrieve and preserve through cryopreservation, gametes (eggs and sperm) for eligible patients at risk of losing their fertility.

Patients must meet the full eligibility criteria set out in the policy in order to have access to treatment.

Patients must be at risk of permanently losing their fertility either through NHS- funded treatment, e.g. chemotherapy or through immediate risk of premature ovarian failure.

See full policy for more details.

To increase the circumstances in which a patient at risk of permanently losing their fertility may access CCG-funded gamete retrieval and cryopreservation in line with new eligibility criteria.

Previously Birmingham CrossCity and Solihull CCGs had no formal policy that had been approved by their respective governing bodies.

To provide those with naturally occurring ovarian failure or NHS-funded treatments other than chemotherapy or radiotherapy with access to gamete retrieval and cryopreservation.

See draft patient leaflet.

Cough assist machines

The mechanical insufflator/exsufflator (MI-E/ Cough Assist machine) is suggested to assist the clearance of bronchopulmonary secretions in those patients with an ineffective cough by the use of both positive and negative pressure.

Use of cough assist machines is not routinely commissioned

See full policy for more details.

No current policy.

Lack of robust clinical evidence to support the cough assist machine as a clinically effective intervention for this cohort of patients.

See draft patient leaflet.

Bunion surgery Surgery to relieve pain and improve the alignment of the patient’s big toe.

A defined group of patients diagnosed with a bunion will be eligible for surgical intervention under the new policy.

See full policy for more details.

No current policy.

To ensure patients are being treated in line with robust clinical evidence.

See draft patient leaflet.

Treatment for snoring Treatment of snoring with uvulopalato, vulopalatopharyngoplasty, palate implants and radiofrequency ablation of soft palate.

The treatments outlined are not routinely commissioned.

See full policy for more details.

No current policy.

Reviewed clinical evidence does not support the long-term effectiveness of these interventions.

See draft patient leaflet.

Treatment for ear wax Ear irrigation should be carried out where possible in primary care by a suitably qualified clinician.

To define a cohort of patients where ear irrigation is an appropriate intervention.

See full policy for more details.

No current policy.

NICE 2017 Hearing Loss. Hearing Loss in Adults: Diagnosis and Management.  (currently in development, final document due for release May 2018).

To deliver evidence-based care to patients in line with NICE guidance in the most appropriate setting.

See draft patient leaflet.

Umbilical; para-umbilical and Incisional hernias Umbilical, para-umbilical and incisional hernias are common abdominal hernias encountered in clinical practice, and involve the protrusion of intra-abdominal tissue through a defect in the abdominal wall.

To define a cohort of patients diagnosed with a hernia where surgical intervention is the most clinically effective course of action.

See full policy for more details.

No current policy. New policy will complement the existing policy on inguinal (groin) hernias.

To ensure patients are treated appropriately in line with up- to-date clinical evidence.

See draft patient leaflet.

Investigation of painless rectal bleeding Rectal bleeding (loss of blood from the anus) is a very common and usually intermittent and self-limiting symptom in people of all ages. 

To define a cohort of patients in which further secondary care investigation is the most clinically evidence based intervention.

See full policy for more details.

Further defines the cohort of patients suitable for referral and investigation in line with NICE guidance.

National Institute for Health and Care Excellence (NICE) 2015 (Updated 2017) Suspected cancer: recognition and referral, NG12.

See draft patient leaflet.

Lithotripsy to treat small asymptomatic renal calculi Extracorporeal shockwave lithotripsy is a non-invasive outpatient treatment that focuses ultrasound shockwaves on renal stones to fragment them and facilitate spontaneous passage.

To define a cohort of patients where lithotripsy is the most clinically effective intervention.

See full policy for more details.

No current policy.

National Institute for Health and Care Excellence, 2017. (Guideline scope) Renal and ureteric stones: assessment and management

See draft patient leaflet.

Breast implant revision surgery Breast implant revision surgery is defined as “any consequence of an implant that would require an operative approach to managing it (e.g. removal)”.

To define two cohorts of patients in whom the most clinically evidence based intervention is a. surgical removal of the breast implants and b. surgical removal and replacement of breast implants.

See full policy for more details.

No current policy.

To ensure patients are being treated in line with up-to-date clinical evidence.

See draft patient leaflet.

Acupuncture for indications other than back pain Acupuncture is a treatment derived from ancient Chinese medicine. Fine needles are inserted at certain sites in the body for therapeutic or preventative purposes.

Acupuncture is commissioned for two defined cohorts of patients, a. patients suffering from tension-type headaches and 2. Patients suffering from migraine headaches.

See full policy for more details.

No current policy.

NICE Low back pain and sciatica in over 16s: assessment and management. NICE guideline [NG59] Published date: November 2016.

NICE CG150 Headaches in over 12s: diagnosis and management (Nov 2015)

See draft patient leaflet.

Treatment of port wine stain A port wine stain is a vascular birthmark caused by abnormal development of blood vessels in the skin. A port wine stain is sometimes referred to as a capillary malformation. Treatment can include camouflage make-up or laser therapy.

Laser therapy is not routinely commissioned.

See full policy for more details.

In line with current policy.

Lack of clinical evidence to support the long-term outcomes of laser therapy as an intervention in this clinical circumstance.

See draft patient leaflet.

Vasectomy

A vasectomy is a surgical procedure performed on males in which the vas deferens (tubes that carry sperm from the testicles to the seminal vesicles) are cut, tied, cauterized (burned or seared) or otherwise interrupted. The semen no longer contains sperm after the tubes are cut, so conception cannot occur. The testicles continue to produce sperm, but they die and are absorbed by the body.

The purpose of this operation is to provide reliable contraception.

To define two cohorts of patients, one to be treated within the community setting and one cohort requiring intervention within a secondary care setting.

See full policy for more details.

To define a cohort of patients where secondary care treatment is clinically appropriate.

To ensure patients receive treatment supported by robust clinical evidence, in the right place the first time.

See draft patient leaflet.

Reversal of male (vasectomy) sterilisation Sterilisation is a procedure by which a person is rendered permanently unable to produce children – made infertile. This is called Vas Occlusion in men (vasectomy): the tubes that carry sperm from a man's testicles to the penis are cut, blocked or sealed with heat. Sperm is then prevented from reaching the semen ejaculated from a man's penis during sex. Reversal of sterilisation is a surgical procedure that involves the reconstruction of the vas deferens in men but does not guarantee a return of fertility.

Reversal of male sterilisation is not routinely commissioned.

See full policy for more details.

No change to the current policy.

NICE (2016) deem vasectomy to be a permanent method of contraception and the British Association of Urological Surgeons (2017) state clinicians on gaining consent for a vasectomy, should ensure that it is made clear to the patient that the procedure is irreversible.

See draft patient leaflet.

Reversal of female sterilisation

Sterilisation is a procedure by which a person is rendered permanently unable to produce children – made infertile. In women, it is called operative occlusion of the fallopian tubes: cutting, sealing or blocking the fallopian tubes to prevent eggs from reaching the uterus (womb) where they could become fertilised.

Reversal of sterilisation is a surgical procedure that involves the reconstruction of the fallopian tubes in women but does not guarantee the return of a woman’s fertility.

Reversal of female sterilisation is not routinely commissioned.

See full policy for more details.

No change to the current policy.

In guidance to clinicians the Royal College of Obstetrics and Gynaecologists (2016) state that when gaining consent from a woman for a sterilisation procedure, the patient should be informed that reversal of sterilisation is not available on the NHS.

See draft patient leaflet.

Standing/upright MRI Magnetic resonance imaging (MRI) is a type of scan that uses strong magnetic fields and radio waves to produce detailed images of the inside of the body. A standard MRI scanner is a large tube that contains powerful magnets. The patient lies inside the tube during the scan. Positional (upright) MRI has been developed to provide images of the spine under true weight-bearing conditions. This technique relies on a vertically open configuration MRI scanner in which the circular magnets have been turned on end. The patient sits or stands between the magnets during image collection and can adopt various positions such as flexion or extension of the neck or back, allowing imaging of the spine under conditions that occur in daily life.

A defined group of patients will be eligible for access to upright MRI under the new policy.

See full policy for more details.

To define a cohort of patients where upright MRI is clinically appropriate.

Evidence supporting the weight bearing requirement of upright MRIs in certain clinical circumstances.

See draft patient leaflet.

Treatment for chronic fatigue syndrome Chronic fatigue syndrome (CFS) is also referred to as Myalgic encephalomyelitis (ME) or Post viral fatigue syndrome. It is characterised by long-term tiredness that affects everyday life and does not go away with sleep or rest. It can encompass both physical (e.g. fatigue) and psychological difficulties (e.g. muddled thinking).

In patient care or therapy in a residential setting are not routinely commissioned for the treatment of CFS/ME due to the lack of clinical evidence to support this intervention. Patients should be referred for specialist assessment and offered out-patient therapy in the form of a PACE programme comprising of CBT/exercise therapy as appropriate.

See full policy for more details.

No current policy.

NICE (2007). Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy): diagnosis and management. 

See draft patient leaflet.

Complementary and alternative therapies

Complementary and alternative medicines (CAMs) are treatments that fall outside of mainstream healthcare.

These medicines and treatments range from acupuncture and homeopathy, to aromatherapy, meditation and colonic irrigation.

There is no universally agreed definition of CAMs.

Although ‘complementary and alternative’ is often used as a single category, it can be useful to make a distinction between the two terms.

The US National Center for Complementary and Integrative Health (NCCIH) uses this distinction:

• When a non-mainstream practice is used together with conventional medicine, it’s considered ‘complementary’

• When a non-mainstream practice is used instead of conventional medicine, it’s considered ‘alternative’.

There can be overlap between these two categories. For example, aromatherapy may sometimes be used as a complementary treatment, and in other circumstances is used as an alternative treatment.

Complementary and alternative therapies are not routinely commissioned.

See full policy for more details.

The existing policy in this area is not proposed to change and therefore the following will not be routinely funded by the CCG:

Acupuncture, homeopathy, chiropractic, osteopathy, herbal medicine (including Chinese medicine), Alexander technique, Pilates, flower remedies, meditation, Shiatsu, nutritional medicine, yoga, aromatherapy, bodywork therapy including massage, reflexology, healing, hypnotherapy, anthroposophical medicine, maharishi ayurvedic medicine, traditional Chinese medicine, Eastern medicine, naturopathy, crystal therapy, iridology, dowsing, kinesiology.

Review of the clinical evidence did not support the clinical effectiveness of these interventions.

See draft patient leaflet.

NHS Birmingham and Solihull CCG launch event and NHS 70th birthday celebrations

On Thursday 12 July 2018 NHS Birmingham and Solihull Clinical Commissioning Group engaged with over 250 members of the public, GPs and local organisations at a special launch event which also celebrated the NHS’s 70th birthday.

The CCG, which was formed by the merger of Birmingham CrossCity, Birmingham South Central and Solihull CCGs on 1 April 2018, is the largest clinical commissioning group in England.

As part of the event at The Vox Conference Centre, an afternoon of speakers was arranged for local Patient Participation Groups (PPGs) and GPs, followed by a health fair, with stalls provided by Birmingham City CouncilBirmingham Voluntary Service CouncilGateway Family ServicesHealth Exchange UKLiving Well Taking ControlSolihull TogetherHealthwatch Birmingham and Healthwatch Solihull; as well as the CCG.

The formal launch of the CCG was carried out by Chair Dr Peter Ingham and Chief Executive Paul Jennings, who also paid tribute to some of the many supporters of the local NHS for their personal contribution:

  • Howard Tyers, former Senior Staff Nurse at Heartlands Hospital, for support in raising awareness of local NHS issues on social media;
  • Mark Sanders, and his guide dog Lily, for his continuing support and involvement in a range of CCG meetings and for his instrumental role in the development of a minor eye conditions service;
  • Tony Green, for his work with the Solihull PPG network and involvement with Healthwatch Solihull;
  • Bernie Aucott, a Strategic Patient Partner for the CCG who is heavily involved in CCG meetings, boards, committees, events and workshops;
  • Garry Morris, a local photographer, worked in partnership with the CCG to produce a range of images of Birmingham and Solihull to celebrate NHS70.

Read more about the event in our news release.

Repeat prescripton

Following this engagement in March 2016, we created information leaflets to advise patients of the way in which repeat prescriptions would work in the future. Find out more here.

Transforming care for people with a learning disability and autism

Since the Transforming care programme began we have undertaken a number of engagement activities with patients, carers, families and stakeholders. Our first large scale engagement event looked at what was working well and what could be improved for the future. View the event report from March 2016.

Another piece of engagement has been about informing the new service model development. In partnership with The Weaver and Young Foundation we engaged with parents with lived experience of current services. View the engagement report

Minor eye conditions service

We have been engaging with the Birmingham Sight Loss Council, as well as the Thomas Pocklington Trust and some local member of the partially sighted community. More information on this project will be available soon.