The cost of the “available financial envelope”

With all the focus on Brexit, you could be forgiven for missing the reporting this month of a ‘secret’ plan to impose further cuts to the NHS across 14 areas of England.  I know I did.

First up a caveat.  I’m not an expert in any of this; I’m just a guy reading some newspaper reports.  And that said…

This starts in April of this year with a letter from NHS England and NHS Improvement introducing Providers and CCGs to the “Capped Expenditure Process”.  In essence (and I’m paraphrasing here quite a bit):

If your plans don’t come in under the budget allocated to you – or if we don’t think you can achieve them under that budget – then we’ll come and help you to deliver your service under budget.

I really recommend you read the letter.  It’s full of some pretty interesting language.  What most of us would call a budget is known here as an “available financial envelope”.  To stay ‘inside’ that envelope, plans are to be “appropriately ‘lean'”, and “challenging but achievable”.

As I say, I’m not enough of an expert in NHS budgets available financial envelopes to give you any more of an insight than you could get by simply Googling “Capped Expenditure Process”.  And I’m not going to comment here on whether I think there’s an agenda – conscious or otherwise – to defund the NHS to the point of failure so that it can be privatised to ‘save’ it.  That kind of speculation is what I have my personal Twitter account for.

But what I did want to say something about was a specific cut which is being planned for one of the 14 areas being put through the Capped Expenditure Process.  Cheshire.

According to multiple reports (here’s one from The Guardian), recommendations under the CEP for Cheshire include reductions of 25% in the number of endoscopies carried out.  Macmillan has described the plan as “incredibly worrying for cancer patients” and, from my experience, I can understand why.

The journey to my cancer diagnosis started on a Monday when a locum GP decided that instead of another round of antibiotics what I needed was a trip to A&E for an X-Ray. Friday of the same week I was back in hospital for an endoscopy, during which the consultant was able to: confirm their suspicion that I had lung cancer; identify (with some confidence) the type of tumour; take a biopsy of that tumour; and come up with my treatment plan.

Without that endoscopy I’m really not sure my treatment would have been as successful as it was.  Indeed, I don’t know if it would have been successful at all.  It was certainly a critical part of the diagnosis which saved my life.

It’s not a long procedure – mine took perhaps 30 minutes at most.  But it is a frightening one.  Not just because they’re about feed a camera in to you, but because you know what they’re expecting to find.  It was even worse for me because when the consultant took the biopsy the tumour bled… a lot.  It’s difficult to keep calm when you can see the worry on the consultant’s face as he tries to stop you bleeding in to your lungs.

All that is to say that an endoscopy is a fairly traumatic experience for the patient.  Endoscopies aren’t just dished out to keep patients happy, they’re scheduled when they’re considered necessary by experts.

The idea that, in the future, one in every four of those scheduled procedures won’t happen because doctors have been told endoscopies are subject to a “value-based deprioritisation” is appalling and can only lead to worsened outcomes for cancer patients.

I can only hope that with the General Election now out of the way, this “Capped Expenditure Process” and its impact on patients can now get the public attention it needs to keep the changes being proposed in check.


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