That’s not particularly newsworthy, but one headline today caught my eye on the BBC “NHS to stop ‘ineffective’ treatments”. Well – my gosh, surely if they are ineffective they should have been stopped years ago.
NHS England’s Proposals
There are four immediately identified treatments that are proposed to be restricted, one of which is surgery for snoring. Here at Sleep House, we know quite a bit about snoring, so it will be interesting to see the detail of these proposals – such as whether this is for hard or soft tissue or both, any other parameters etc.
But, it remains a fact that in 2005, an esteemed Cochrane review found;
“the available evidence from [a number of] small studies does not currently support the widespread use of surgery in people with mild to moderate daytime sleepiness associated with sleep apnoea.”
And if that is the position for mild to moderate apnoea, it would seem reasonable to suggest that the situation would be the same for snoring, given that snoring is one of the main symptoms of obstructive sleep apnoea (OSA) and valid proven treatments for OSA exist.
How many other reports like this are being worked through to find ways to cut costs?
No doubt some excellent savings ideas will be found – but I worry that decisions could be made on an initial cost basis – without considering the long term implication. Hopefully the consultation process will address these concerns – but then how much do the consultations processes cost?!
Further to that, if the proposals go through, there is potential that asking for a particular treatment could become a postcode lottery where it is easier to make such a request in one region than another. Consider this, if your GP or specialist doctor didn’t offer a treatment you’d heard about, would you feel comfortable asking for your request to be considered or reconsidered? I suspect most people would not.
We know that the NHS is going to have to change, and I personally want to see it continue. I’m a massive fan, particularly having availed myself of its’ services for childbirth, and a handful of A&E visits for my family (hey – kids will be kids). What staggers me is that sometimes there are effective options – from a cost and patient outcome perspective, that remain largely unknown.
With snoring, for example, (and mild to moderate obstructive sleep apnoea), there is a treatment that does not involve surgery, and in very simple terms, holds the lower jaw forward, which in turn holds the airway open, stopping the snoring. (I could get more technical, but that will do for now). Many doctors don’t know this is a valid treatment option, and it isn’t known by most dentists who, once trained, could prescribe this treatment.
So why is this?
Sleep, is still not a part of core medical or dental training… so how on earth can we expect our doctors to know much about it.
I hope that the cost cutting and optimisation exercise that the NHS is going through at the moment has a phase to it that looks at treatment options, that turns to the available research to publically recognise and actively promote alternative or relatively unknown treatment pathways that continue the legacy of serving patients, and doing so in such a way that it is cost effective to the public purse.
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Post created by Emma Easton. Last updated 3rd July 2018.
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- Sundaram S., Lim J., Lasserson T.J., (2005) Surgery for obstructive sleep apnoea in adults (review), Cochrane database of systematic reviews, issue 4. Available here: http://www.cochrane.org/CD001004/AIRWAYS_surgery-for-obstructive-sleep-apnoeahypopnoea-syndrome
Over to you
Is there a solution? How would you solve the conundrum of spiralling budgets and patients’ expectations?
Leave a comment below right now.