Treatments paid for by the NHS

Treatments paid for by the NHS image.jpeg As an NHS Integrated Care Board (ICB) we are looking at how we spend NHS money in West Yorkshire and what treatments we pay for. Up to now, some of these choices have been different depending on where people live.

We are therefore reviewing our commissioning policies to make sure everyone gets the same access to treatments, wherever they live in West Yorkshire. This will also make sure all our policies are in line with the latest expert advice.

All our commissioning policies can be viewed on the commissioning policies page here.

We have looked at 32 commissioning policies so far. Commissioning policies are documents that contain information about treatments, and who can have those treatments paid for by the NHS. We are making changes to eight of these policies. Some people living in West Yorkshire could be affected by these changes.

Involvement around the recommendations for these policies has taken place. For more details about this involvement, please see this page Your views on treatments paid for by the NHS.

Please see the information below which gives updates on the eight policies.

Update 28 February 2024

Changes to gluten-free prescribing

At its meeting on 31 October 2023, the NHS West Yorkshire Integrated Care Board (ICB) Transformation Committee agreed that gluten-free prescribing would be stopped in Calderdale and Leeds to bring them in line with the other West Yorkshire places (Bradford District and Craven, Kirklees, and Wakefield District).

Following feedback from patients and the public, clinical staff within West Yorkshire and Coeliac UK, NHS West Yorkshire ICB paused the decision and committed to undertake a comprehensive review of all available information.

The Transformation Committee met again on 27 February 2024 to reconsider this policy and agreed that gluten-free prescribing would be stopped in Calderdale and Leeds. This does not apply to patients who require low protein gluten-free foods.

It may be helpful to note please that we work alongside our colleagues as part of the clinical and care professional forum, which includes doctors, and that no decision is taken lightly.

All gluten-free prescriptions will be stopped from 1 April 2024. Gluten-free prescriptions are not available for those newly diagnosed with coeliac disease from 1 March 2024.

This is the new (February 2024) commissioning statement for gluten-free prescribing. Please see the Frequently Asked Questions further down this page for more information. If you would like to ask a question, or make a comment or complaint about this decision, please email the ICB Governance Team at: westyorkshireics.governance@nhs.net or call: 01924 213050 (Monday to Friday 9am to 5pm).

We fully appreciate that this is not the outcome people would have wanted and understand that the cost-of-living crisis is very difficult for many people living in West Yorkshire.

Coeliac UK asked the ICB for reassurance that plans would be in place to monitor impact if withdrawal of provision takes place in Calderdale and Leeds. The West Yorkshire places where gluten-free prescribing was stopped in 2016/2017 have shared details of how this was implemented, and what measuring and monitoring processes are currently in place for coeliac patients in their areas. This includes supporting coeliac patients through the healthcare professionals providing links through to national support groups. It is important that people with coeliac disease highlight any issues they are having accessing gluten-free products so that the healthcare professional caring for them can discuss the best possible options with them. NICE has this page on the management of coeliac disease, which is shared with people when they are diagnosed.

Any additional communications about managing coeliac disease are shared with local community groups so that they can continue to help its local communities.

This also includes working with local partners to look at how people can be helped to access food suited to their dietary needs, for example Bradford District and Craven’s community networks help signpost people to where they can access gluten-free foods and information that helps support a gluten-free diet.

Background

The NHS began funding gluten-free products for people with coeliac disease and people with other gluten-sensitive conditions in the late 1960s when availability of gluten-free products was very limited. Once a wide variety of gluten-free products became available in supermarkets, many areas in England stopped providing them on prescription.

Gluten-free prescribing was stopped in Bradford District and Craven in 2016, and in Kirklees and Wakefield District in 2017. However, in Calderdale and Leeds, limited gluten-free products were still prescribed.

These six policies are for types of cosmetic surgery that change how people look. They are sometimes called ‘aesthetic’ procedures and are paid for by the NHS for health reasons.

Treatments include cosmetic surgery on the stomach area (abdomen), body contouring (surgery to remove excess skin and fat) and liposuction (to suck out excess fat). Some people who have lost a lot of weight may benefit from having these treatments.

Some cosmetic surgery to alter the shape, size or position of the breasts is also included. As is the breast reduction policy for gynaecomastia (enlarged male breasts). Some people who have lost a lot of weight may benefit from having these types of breast surgery. This does not include breast surgery for cancer patients.

To have one of these treatments paid for by the NHS, there are certain requirements. One of those requirements is the person’s body mass index (BMI). This is a measure that uses a person’s height and weight to work out if their weight is healthy.

On 31 October 2023, the ICB Transformation Committee approved the recommendation that a person would need to have a BMI of 27 or below to have one of these procedures paid for by the NHS.

This encourages healthier lifestyle choices. It also reduces the risk of complications during surgery and increases the chances of recovering better and quicker after surgery. The new policy will not apply to people who are already on the waiting list for one of these procedures, or to those who are waiting to be assessed following a referral from a GP or other healthcare professional. It will apply to all new referrals.

What could this mean for me?

In Calderdale and Kirklees, the BMI requirement for all six of these cosmetic procedures was already 27 or below. This means there will be no change for people living in Calderdale and Kirklees.

In Bradford District and Craven, the BMI requirement for cosmetic breast surgery was already 27 or below so there will be no changes with these breast surgery policies.
The BMI requirement for liposuction was not previously stated. Setting the BMI to 27 or below will give clarification that people living in Bradford District and Craven will need to be at a BMI of 27 or below before being able to have liposuction paid for by the NHS.
The BMI requirement for cosmetic stomach surgery and body contouring was 30 or below. This change means that people living in Bradford District and Craven will need to lose more weight before being able to have cosmetic stomach surgery or body contouring paid for by the NHS.

In Leeds, the BMI requirement for all six of these cosmetic procedures was 30 or below. Setting the BMI to 27 or below means that people living in Leeds will need to lose more weight before being able to have one of these treatments paid for by the NHS.

In Wakefield District, the BMI requirement for these procedures was already 27 or below except for liposuction which was 30 or below. This means that patients in Wakefield District will need to lose more weight before having liposuction paid for by the NHS.

The new commissioning policies for these procedures are available to view at the links below:

Please see the Frequently Asked Questions further down this page for more information. If you would like to ask a question, or make a comment or complaint about this decision, please email the ICB Governance Team at: westyorkshireics.governance@nhs.net or call: 01924 213050 (Monday to Friday 9am to 5pm).

Ear correction surgery can be done to alter the size or shape of the ears, or to pin back ears that stick out.

On 31 October 2023, the ICB Transformation Committee approved the recommendation for this treatment to be available on the NHS for children and young people from age 5 to 18. This puts the ear correction policy in line with other treatments for those aged 18 and under. It is also in line with NHS guidance.

What could this mean for me?

In Bradford District and Craven the age range for ear correction was already 5 to 18 so there is no change.
In Leeds, the age range was 5 to 16 so the upper age limit has been increased from 16 to 18.
In Calderdale, Kirklees and Wakefield District, the age range was 5 to 19 so the upper age limit has been reduced from 19 to 18.

The new commissioning policy for ear correction surgery is available to view here. Please see the Frequently Asked Questions further down this page for more information. If you would like to ask a question, or make a comment or complaint about this decision, please email the ICB Governance Team at: westyorkshireics.governance@nhs.net or call: 01924 213050 (Monday to Friday 9am to 5pm).

Many of the policies reviewed so far are already the same across West Yorkshire. Some policies that were different have been enhanced to make them the same. This means that no one will be negatively impacted by any changes. These policies are listed below and are all available to view on our commissioning policies page.

Allergy treatments
Circumcision
Constipation - sacral nerve stimulation
Cryopreservation for fertility treatment
Earlobe repair
Eye floaters - laser vitreolysis and vitrectomy
Facial procedures – facelift, brow lift, droopy eyelids
Foot drop - functional electrical stimulation
Headache - specialist services
Irritable bowel syndrome - psychological interventions
Labial reduction and cosmetic vaginal procedures
Laser treatments not covered elsewhere
Lycra garments
MRI open upright scanning
Nipple inversion (benign) correction
Nose surgery
Nose swelling - rhinophyma
Scar treatment including acne
Tattoo removal
Thread veins
Toric lens insertion
Vascular skin lesions
Vasectomy and female sterilisation reversal

Frequently Asked Questions

On 1 July 2022, the responsibility for commissioning (planning and buying) healthcare treatments for the population of West Yorkshire was moved from clinical commissioning groups (CCGs) to the newly formed NHS West Yorkshire Integrated Care Board (the ICB). The ICB became the statutory body (set up by law) responsible for commissioning as part of the Government’s new Health and Care Act. CCGs made local decisions around their commissioning policies which resulted in some differences across the West Yorkshire area.

Now that we are one statutory organisation, we must have single commissioning policies for the whole of West Yorkshire. This is why we are reviewing and aligning our policies to make them the same so there are no differences. Having single commissioning policies will help us make the best use of limited resources and ensure that everyone living in West Yorkshire has equal access to the same healthcare treatments.

NHS resources are limited. As an integrated care board (ICB), collectively across West Yorkshire, we now have to make some difficult decisions about how we spend our money. If we were to re-start gluten-free prescribing across the entirety of West Yorkshire this would have a significant financial impact on the NHS in West Yorkshire and would take money away from other health and care services.

We know that manufactured gluten-free products, and foods that are naturally gluten-free, including meat, fish, vegetables, fruit, rice and most dairy products, are now widely available in supermarkets.

Over the last few years, it has become much easier for people to follow a gluten-free diet without a prescription. Our policy of not providing gluten-free products on prescription covers all of West Yorkshire to enable the best use of NHS resources for our entire population.

Gluten-free products will not be available on prescription in Calderdale and Leeds from 1 April 2024 for existing coeliac patients, and from 1 November 2023 for newly diagnosed coeliac patients.

Gluten-free products are readily available in supermarkets, other shops and online so the majority of coeliac patients do have easy access to them. Many low cost foods including potatoes and rice are naturally gluten-free so it is possible to follow a gluten-free diet without prescription products.

The ICB is developing some patient information to support people through the transition period. There is already a lot of dietary advice online that you may find helpful, including Coeliac UK’s Food and Drink Information which gives the product suitability on nearly 150,000 gluten-free and mainstream foods.

The places where gluten-free prescribing was stopped in 2016/17 (Bradford District and Craven, Kirklees and Wakefield District) have different approaches to support coeliac patients depending on population need. Some of these approaches, or alternative approaches, may be introduced in Calderdale and Leeds to support their patients who will no longer have access to gluten-free products on prescription from 1 April 2024.

There may be exceptional circumstances where a GP or other healthcare professional believes a patient should have a treatment or a procedure that is no longer routinely available. If your healthcare professional believes that your circumstances are clinically exceptional, and that you should be prescribed gluten-free products, they can ask the NHS to pay the costs. To do this, your healthcare professional would need to complete an individual funding request on your behalf.

A person who has lost a lot of body fat may have excess skin or skin folds that are not only impacting on their body image but are a health problem in terms of the increased risk of skin infections and ulcers for example. In such cases the surgery will be available at a BMI above 27.

Evidence from various studies tells us that achieving a BMI of 27 or below before surgery has a positive effect on different anaesthetic risks, wound healing rates, rates of postoperative infection and the ability for people to get mobile after surgery. This patient information leaflet produced by Oxford University Hospitals NHS Trust explains that there can be a higher risk of surgical and anaesthetic complications for patients with a BMI of 30 or above.

We developed a framework to understand the impact on the numbers of people who might require treatment if we set the BMI to 27 or below, and if we set the BMI to 30 or below. The data tells us that having a lower threshold doesn't correlate with having lower levels of activity per head of population. We don’t expect to see any changes in activity levels, and therefore any increased or decreased costs, for these procedures as a result of this change. We had to choose one way or the other so we went for the option with the lowest clinical risk.

The ICB Transformation Committee made the decisions on gluten-free prescribing, the six cosmetic surgery (for health reasons) policies and the policy for ear correction surgery at its meeting on 31 October 2023.

In making these decision, the committee considered feedback from patients and the general public which was gathered earlier this year. If you took part in this involvement, thank you for taking the time to share your views and get involved. Please see our web page Your views on treatments paid for by the NHS for more information about the involvement.

Treatments paid for by the NHS

Gluten-free prescribing

Changes to gluten-free prescribing

Background

Cosmetic surgery (six policies)

What could this mean for me?

Ear correction surgery policy

What could this mean for me?

Policies with no changes and policies with enhancements

Frequently Asked Questions

Why are we having the same commissioning policies across West Yorkshire?

Why can’t gluten-free products be prescribed everywhere in West Yorkshire, rather than stopping it?

What does this mean for patients who are prescribed gluten-free products?

What support is there to help me follow a gluten-free diet without prescription products?

What can I do if I’m unable to stick to a gluten-free diet without prescription products?

What about people with a lot of muscle who have a high BMI?

How do we know that surgery at a BMI of 27 or below less of a risk?

Is this about medical opinion on BMI or is there a financial aspect?

Who made these decisions?

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