Updated NICE Guidelines for Sleep Apnoea

Updated NICE Guidelines for Sleep Apnoea

In my view improving NHS provision and fast tracking certain individuals, at this time of austerity, has for any rational person to be considered at best, highly unrealistic.

At Snorer.com we applaud the intent behind the 2015 updated NICE Guidelines for Obstructive Sleep Apnoea Syndrome (OSAS) new-window.
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However, we feel duty bound to point out that the reality is sadly somewhat different to the aspirational view the Guidelines suggest.

Fast tracking those in ‘hazardous roles’ is absolutely the right thing to do, but we have a new Conservative Government (new Parliamentary session commenced today 27th May 2015) and the prospect of a £30bn cuts programme to tackle the deficit. In my view improving NHS provision and fast tracking certain individuals, at this time of austerity, has for any rational person to be considered at best, highly unrealistic.

Getting prompt help through the NHS (or for that matter any help at all with sleep apnoea) depends upon your success in obtaining at least two things:

1) Your local Doctor recognising your symptoms and being able to do anything much about it. This requires more than just education. Your local Doctor is now in a quandary: They can no longer do much more than ‘paper screen’ (they may also be employed by a Private Provider who limits what they can and cannot do).

They also know that their sleep unit (if there is one locally – see below) is bursting at the seams. So they cannot know with any degree of confidence if you need to be seen at specialist level…. Do they make the referral and add you to the already overstretched service?

2) Capacity of your local sleep unit (that is if you are one of the lucky 15% of UK citizens that have access to appropriate treatment – see British Lung Foundation, OSA Health Economics Report 2014 PDF new-window).

According to the BLF just 15% of those with OSA have access to treatment

Here is the exact quote from the BLF, OSA Health Economics Report 2014 (see page 5):


… the proportion of people with OSA that do not have access to the most appropriate treatment is still very high (up to 85%). Evidently there are difficulties in identifying patients and referring them to the right specialist, and in implementing NICE’s recommendation at the local level.

 

In our view, several things, including the below, need to change:

    1. Local Doctors need education and funding so they may screen using something like the OSA50 questionnaire and an SpO2 recording device (at a minimum) to recognise symptoms of sleep apnoea and then make more informed referrals
    2. Diagnostic capacity and sleep apnoea treatment provision needs to be more widely available (both geographically and financially)
    3. Those employed in hazardous roles should be prioritised all the way from the local Doctor to diagnosis and in turn on to treatment (and not in effect stigmatised and financially penalised as they are at present)

Until these things change the updated NICE Guidelines are just that: very ‘nice’, a step in the right direction perhaps or a ‘signal of intent’ but sadly completely out of touch with NHS financial reality.

So then, as a Country, we need to consider the mismatch between our financial support of the NHS and our demands from it, which perhaps means we need to swallow the pill of Private Provider provision of services complementary to those offered by the NHS and/or subscribe to employer provided healthcare schemes. What do you think?

Postscript: I consider OSAS therapy should include prescription, custom, adjustable oral appliance therapy through a sleep trained Dentist as well as PAP (available when medically necessary and not just ‘indicated’ and available to those who can pay). Perhaps that is even more unrealistic!

Created by Adrian Zacher new-window | Page last updated 27 May 2015