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Tonsils removal, breast reductions and snoring surgery will be offered to far fewer patients from next year, under plans being drawn up by NHS England.

Officials are to discuss proposals to stop or reduce 17 routine procedures deemed to be “ineffective or risky”.

The treatment will be offered only if it is judged to be of “compelling” benefit and there are no alternatives.

NHS England said the move would affect about 100,000 people every year and free up an estimated £200m.

It follows reviews last year to save £190m from supplying over-the-counter medications and treatments described as “low value”.

NHS England says for most of the 17 procedures under consideration, alternative treatments including physiotherapy, a minor injection or change of diet are likely to be effective.

NHS England national medical director Prof Stephen Powis said: “If we want the very best clinical care for our patients, we need to stop putting them through treatments where risks and harms outweigh the benefits.

“By reducing unnecessary or risky procedures for some patients we can get better outcomes while reducing waste and targeting resource to where it is most needed.”

The plans have the backing of health professionals and the National Institute for Health and Care Excellence (NICE), which advises on the clinical benefits and cost-effectiveness of treatments.

But patients at risk of serious harm from their condition will continue to be offered treatment.

It is proposed four treatments will be offered only when a patient makes an individual request.

These include surgery for snoring, where there is said to be only limited clinical evidence of effectiveness and which poses significant risks to patients.

The others are: dilatation and curettage for heavy menstrual bleeding, knee arthroscopies for osteoarthritis and injections for non-specific back pain.

A further 13 procedures will only to be offered when specific criteria are met:

  • Breast reduction
  • Removal of benign skin lesions
  • Grommets for Glue Ear
  • Tonsillectomy for sore throats
  • Haemorrhoid surgery
  • Hysterectomy for heavy menstrual bleeding
  • Chalazia (lesions on eyelids) removal
  • Anthroscopic compression for subacromial shoulder pain
  • Carpal tunnel syndrome release
  • Dupuytren’s contracture release for tightening of fingers
  • Ganglion excision – removal of noncancerous lumps on the wrist or hand
  • Trigger finger release
  • Varicose vein surgery

NHS England chief executive Simon Stephens says with more money committed by the government the health service must now work harder to tackle waste and reinvest savings.

He said: “The NHS is already independently ranked as one of the most efficient health services in the world.

“Precisely because the NHS is owned by the public, all the savings we now make will be directly reinvested in better frontline cancer, mental health and other critical services.”

NHS England plans to consult publicly on the proposals between 4 July and 28 September, with changes planned to start in 2019-20.

Academy of Medical Royal Colleges chairwoman Prof Carrie MacEwen said: “These are evidence based proposals which have been subject to clinical scrutiny.

“The Academy of Medical Colleges supports the overall programme which will benefit patients, clinicians and the NHS as a whole by reducing harm and targeting those who will benefit most.”


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