NHS Tough Choices – Surgery for Snoring to be chopped?

NHS Tough Choices – Surgery for Snoring to be chopped?

The NHS is having to make more tough choices

Emma is passionate about helping people and trying to make things better. With a unique perspective on healthcare and sleep, she also blogs as The Snoring Lady.

Emma Easton

Head of Amazing, Snorer.com

That’s not particularly newsworthy, but one headline today caught my eye on the BBC “NHS to stop ‘ineffective’ treatments”. new window 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.

Awareness issue?

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.

NHS related posts

Here are some related NHS, sleep and regulatory posts from Snorer.com

The Destruction of GP/Patient trust – Guidelines from the GMC

The DVLA and General Medical Council (GMC) in March 2016, reinforced the fact that it is the individual’s responsibility to cease driving and inform the DVLA, should anything impact upon ability to drive safely. They went on to impose a significant and impossible burden on the GP.

read more

References

  1. 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.

The Destruction of GP/Patient trust – Guidelines from the GMC

The Destruction of GP/Patient trust – Guidelines from the GMC

There is no solace in saying ‘Told you so’

When I invented the ASAP Anonymous Sleep Apnoea Process™ in 2012, I understood that some people, for their own reasons, will not consult their GP about their symptoms of obstructive sleep apnoea. Trust was in doubt.

Some years later, certain individuals failure to declare their relevant medical history, hit the headlines. Think Glasgow refuse lorry.

The DVLA and General Medical Council (GMC) responded in March 2016, by reinforcing the fact that it is the individual’s responsibility to cease driving and inform the DVLA, should anything impact upon ability to drive safely. They went on to impose a significant and impossible burden on the GP.

While recognising patient trust would be at risk, they decided to compel the poor GP, (in circumstances where they consider the patient is excessively sleepy and intending to continue to drive) to determine whether the patient’s confidentiality is of lesser importance than the risk to wider Society the patient may represent, should they maintain such trust.

In one fell swoop, belief in a confidential medical conversation, was destroyed. That is of course, if you consider the populations in question, ever felt secure enough to consult their GP….

As a consequence, trust between GPs and patients, arising from the threat of disclosure of medical history to the DVLA, has been comprehensively obliterated. From recent conversations, which I and my colleague have had with GPs, they are as you can imagine less than happy about this.

Here is the exact quote from the GMC, “Confidentiality: reporting concerns about patients to the DVLA or the DVA” [accessed 25 April 2016].

Personal information may, therefore, be disclosed in the public interest, without patients’ consent, and in exceptional cases where patients have withheld consent, if the benefits to an individual or to society of the disclosure outweigh both the public and the patient’s interest in keeping the information confidential.

I wrote about sleep apnoea testing and data privacy previously, highlighting the risks of actions that inadvertently compromise people and going into the difference between anonymous and confidential testing.

There is no solace in saying “told you so”.

Find out about anonymous sleep apnoea testing.

 

References

Updated April 2017 Ethical Guidance from the General Medical Council external_link3 and also see page 8 of the PDF ‘Assessing Fitness to Drive’ external_link3 produced by the DVLA.

 

Learn more:

If you are an employer and want to reduce your exposure to sleep related incidents
Anonymous and confidential testing compared

Page last updated 29 Jan 2018.

Sleep Apnoea Testing & Data Privacy – How do they relate?

Data Privacy Day

Today, 28th January is #DataPrivacyDay. If you don’t know why data privacy and seeking help for sleepiness could potentially threaten your income and career, you need to read this.

Data Privacy day

We really do NOT want to discourage sleepy people from seeking help

However, common belief is that we can safely consult our GP and seek their help if we are concerned about feeling excessively sleepy. The GP would check us out and perhaps refer us to a specialist for tests.

So what has Data Privacy got to do with this?

Risks of inaction

If you’ve seen the News, you will appreciate that some people do NOT consult their GP about their known or suspected medical conditions; with tragic consequences for themselves and innocent others.

The risks of inaction are perfectly evident.

Risks of action that inadvertently compromise

What might not be so obvious, is that confidentiality isn’t really that ‘confidential’ anymore.

If you see a GP they are now urged to report unfit drivers to the DVLA. 1 (The poor GP is in a difficult position here – wanting to help you and balancing a requirement to protect the public from harm).

Data Privacy

So, people may turn to the private sector. Sleep apnoea testing is readily available and most people won’t consider that there could be a risk to their privacy. There is an assumption that private data is ‘safe’ as it is kept ‘confidential’ and indeed it’s not shared with a GP or voluntarily communicated by the vendor – after all, that’s what we have data protection for, right?

Sadly that’s wrong too

Testing ‘confidentially’ no longer means medical data is safe from being divulged to others. Particularly if there is a criminal investigation following an accident (such an accident being much more likely if you have undiagnosed and untreated sleep apnoea).

Confidential testing will still associate nominal data (i.e. your NAME) and other identifiers with medical test results and GPs are guided to act on mere suspicion rather than objective, proven fact.

Classification of medical data

TermExplanation
AnonymousNO NAMES are used or any other personal identifiable data.
Your sleep study test results are stored separately from personal identifiable data and nobody - not even snorer.com or the consultant that confirms the diagnosis knows who the report belongs to.
ConfidentialSleep study test results are associated with key personal identifiable data e.g. name, address, DoB, postcode and other identifiers.

If you were unlucky enough to be involved in a serious accident, your medical history could be requested by and released to:

  • the Police
  • your employer
  • your insurer(s)

With the available ‘confidential’ sleep tests your results are still associated with key personal identifiable data e.g.

  • name
  • address
  • date of birth
  • postcode
  • and other identifiers

NHS data has already been sold to insurance companies 2 and continues to be, even though thousands of records were unlawfully sold in the past.

This is why data privacy is important if you want to seek help for sleepiness – ‘confidential’ tests connect you with your results, and these results could be made available to others.

Yes, you could use an alias for ‘confidential’ testing – but if home based you’ll still have to provide correct address details in order to receive the testing equipment, and if you visit a laboratory, then you’ve exposed yourself visually to staff, and probably on CCTV too!

The only viable alternative

Sleep apnoea testing with Snorer.com is very different.

We really do NOT want to discourage sleepy people from seeking help. But if consulting a GP is not an option and you’re concerned about private, ‘confidential’ testing, where your data could be at risk, what are the options?

The only viable option is to make the process anonymous and in so doing, make it risk free. Names, addresses and so on are unable to be connected with results. Even the team at Snorer.com can’t connect the dots if we were asked to.

Funnily enough, anonymous home sleep testing (ASAP™) is exactly what we’re offering, in partnership with Papworth Hospital NHS Foundation Trust. It is available to individuals who want to keep their private information private and to employers where it makes stark economic sense for them to support their employees in diagnosis and effective treatment.

#DataPrivacyDay #DataAware

If you are worried about snoring and/or experience excessive daytime sleepiness consult your Doctor or a sleep trained Dentist. You can find a sleep trained Dentist on our Links page. If contacting your Doctor about sleepiness is not an option for you consider the ASAP Anonymous Sleep Apnea Process℠.

Reference:

BBC “GP’s urged to report unfit drivers to the DVLA” http://www.bbc.co.uk/news/health-34912771 external link icon [accessed 28th Jan 2016]

Reference: The Telegraph “NHS to carry on selling patient records to insurers” http://www.telegraph.co.uk/news/health/news/11256570/Tens-of-thousands-of-medical-records-handed-to-researchers.html external link icon [accessed 28th Jan 2016]

BBC “Trust me – I’m a Doctor” – Screening

BBC “Trust me – I’m a Doctor” – Screening

UK Audience only
Did anyone see the BBC TV programme “Trust me – Im a Doctor”? It was on TV last night (18 Oct 2013) and discussed different types of testing for a condition, in apparently healthy people.

The ‘take home’ message was provided by Prof Nicholas Ward, an expert in preventative medicine. He gave these three criteria for a test, as to whether it was useful:

  1. Screening for a specific disorder that is serious and can’t adequately be treated if you allowed it to develop in the normal course. In other words, early detection confers an advantage.
  2. You have a test that can separate that population into a group that will get that disease and one that won’t. Separates them quite well.
  3. That you have a remedy you can offer to those people you have picked up from screening. If there is no remedy then there is no point in doing the screening at all.

With regard to obstructive sleep apnoea (OSA), screening or testing meets these 3 criteria and more than that, the mere awareness that you have a condition – providing education – permits you to change your behaviour (i.e. not drive when sleepy) and perhaps will mean you can slow down and/or reduce the severity of your condition. For example losing weight, giving up smoking, eliminating evening alcohol and positional therapy.

In the UK, sleep-trained dentists may screen and recognise OSA symptoms and refer those they suspect need further investigation to their GP, while providing custom-made anti-snoring devices for non-sleepy snorers.

We train dentists how to do this with our online course.

Related

I Hate Instant Snoring Cures – they do more harm than good
Chinstraps Don’t Stop Snoring
OTC Anti-Snoring Devices available on the internet or pharmacy

Sleep well.

If you are unsure about your medical condition, please DO consult a Doctor with experience of sleep medicine. I strongly support providing current, accurate medical information so that individuals are better able to make informed decisions about their health care.

Grab our GP Guidelines and take them with you.

Page last updated 11th May 2018

BBC Breakfast – Snoring & Sleep Apnoea interview with Dr Dev Banerjee

BBC Breakfast – Snoring & Sleep Apnoea interview with Dr Dev Banerjee

Snoring & Sleep Apnoea Discussion – BBC Breakfast

Breakfast anchors Bill Turnbull and Louise Minchin interviewed a CPAP (continuous positive airway pressure) user Chris Fitzgerald and Dr Dev Banerjee a ‘Sleep Expert’.

Below are some notes and my comments re the interview.

Why?

Well, the interview was actually pretty good (with one exception which I have commented on) despite the disappointing ‘humourous’ review of home remedies for snoring that preceded it.

Chris Fitzgerald began (CPAP user) and relayed that for him his snoring was a ‘massive problem’ his ‘kids use to wake him up’ and he received ‘dig in the ribs’.

Dr Banerjee stated that there were lots of devices that don’t work and how important it was for a product to have undergone randomised controlled trials – which CPAP had.

Louise Minchin asked ‘When does irritating snoring become a medical issue and you need to go and see a GP [primary care physician] about it?’

Dr Banerjee replied ‘When there are breathing problems at night time’

At this point I must comment that frustratingly, a poor correlation exists between sleep apnoea severity and the individual’s awareness of their problem. A significant number of snorers are unaware of their breathing difficulties (apart from the noise!). Sadly, partner reporting of the occasional long periods of silence between snores is unreliable as the snorer continues with this pattern all night, long after the observer has gone to sleep themselves. 

Bill Turnbull then asked about the individuals weight ‘… has something to do with it doesnt it?’

Dr Banerjee ‘Definitely, if you are heavy around your neck this exacerbates snoring’

Chris F ‘I tried to lose weight with no success’ and continued to relay his difficulty with this. ‘CPAP… absolutely brilliant…it blows a continuous positive air pressure up your nose, you wear the device strapped around your head. I know it looks a bit silly… you get used to it’. He went onto say that the noise the machine made was ‘…like a humming noise, like you were on an aeroplane – humming drone that you doze off with – you know’.

Bill T ‘Looks really uncomfortable’. Chris F ‘Its not’. Louise M ‘Its got gel on it’. Chris F ‘Its a gel mask and seals around your nose’. 

Bill T ‘Its only if you sleep on your back – what if you turn on your side?’ Chris F ‘You can sleep anyway you like – and the hose follows you’.

Louise M ‘So this works for you?’ Chris F ‘Brilliant…Yeah, once you get used to it – something on your nose all night’.

Bill T asked Dr Banerjee ‘Not everybody can have this on the NHS can they? How expensive is it?’ Dr Banerjee replied ‘Yes, on the NHS and it is the first choice treatment and a very important part of the treatment repertoire for sleep apnoea, and it works and has been proven in randomised clinical trials. And I am a big advocate of this type of machine’.

Louise M stated ‘There are other devices that are similar that are available?’ Dr Banerjee replied ‘Yes. There are lots of different models of blowing machines – CPAP – definitely the treatment for moderate to severe sleep apnoea’

Bill T then asked ‘So, you are stuck with this for life – or does it cure you – what happens?’ Chris F responded ‘I think I am stuck with this for life and to be honest with you before I used this machine I used to wake up every ten minutes so never got a good nights sleep’. Louise M ‘Well you have a serious medical issue with snoring’. Chris F ‘Its just because its loud and wakes me up and everybody else in the house. If you wear this its alright’.

Bill T then asked Dr Banerjee ‘People think I have a bit of a snoring problem but its not my problem, its everybody elses problem other than mine. There is a reluctance to go to a Dcotor and say “I’m snoring a bit” is there anything they can do before they go to see their GP? [Primary Care Physician]Dr Banerjee replied ‘Well they should come to my clinic – by the time they come to me clinic I’m acting as a pseudo marriage counsellor. And it is a problem and no laughing matter. If clearly there is a medical issue as well as ear, nose and throat go and get specialist advice’. 
Chris F replied that
‘It can cause other problems, you know it can affect your heart’

Bill T then changed the topic to ways in which Chris F had tried to get some rest and not disturb his family. Chris F had built a bed in his garden shed and it was ‘…marvellous…shut the door and go to sleep and nobody bothered me. I didnt get the proverbial dig in the ribs’. Bill T asked ‘Didnt you wake the neighbours then?’ Chris F responded ‘Well, I don’t know!’. 

Bill T asked ‘Whats it called?’ Chris F stated that it was ‘C P A P – continuous positive air pressure – they’re brilliant’. Bill T to Dr Banerjee ‘Have you tried one?’. Dr Banerjee ‘Yes, I have’. Bill T replied ‘Was it alright?’. Dr Banerjee ‘It was great’.

A useful interview with some of the stereotypical concerns addressed. I applaud the BBC for the interview if not for only putting the disappointing review of home remedies for snoring on iPlayer.

Disappointing link here (viewable from the UK only). Link deleted as no longer available (May 2018).

Sleep well. If you are unsure about your medical condition, please DO consult a Doctor with experience of sleep medicine. I strongly support providing current, accurate medical information so that individuals are better able to make informed decisions about their health care. If you think you have a sleep disorder please seek appropriate medical advice.

Grab our GP Guidelines for snoring and sleep apnoea and take them with you.

Created by Adrian Zacher, last updated 14th May 2018.