​​Your local NHS is asking people for their comments about proposals to reduce differences in access to healthcare services in the Black Country.

​​In July 2022, a change in the law created our new organisation, NHS Black Country Integrated Care Board (ICB), to take over local healthcare planning from the former clinical commissioning group (CCG) serving the areas of Dudley, Sandwell, Walsall, and Wolverhampton. 

​​Since the ICB establishment we have been reviewing our clinical policies. This includes:

  • reviewing the four existing CCG policies to harmonise them into one new position for the ICB
  • implementing new policies to take into account national clinical guidelines and best practice.

While the majority of their clinical policies were similar, there were several clinical polices that had some differences. To address these differences, commissioning policies for treatments listed below are being reviewed to look at how they can be made the same for the places of Dudley, Sandwell, Walsall, and Wolverhampton. 

​Clinical experts have looked at the latest evidence and practice for all of these services, both nationally and locally, to ensure the local offer is high quality and safe.

The clinical policy review will be carried out in stages.

​​A public involvement exercise is now live to collect wider views and feedback from local people and staff to inform our final decision-making.  

Each proposed policy is listed below, along with details of the proposed changes and the new proposed policy. If you would like to comment on one or more of these proposed policies, please complete this online form by 11.59pm on Monday 26 February 2024.

For reference when you see NICE, we refer to the National Institute for Health and Care Excellence and EBI stands for evidence-based intervention which is the national policy position.

This is a harmonised policy.

The proposed policy states:

  1. Hysterectomies will not routinely be funded as first-line treatment for women who present only with heavy menstrual bleeding. There is an expectation that other treatments will be considered first depending on the underlying cause.
  2. Hysterectomies will be funded for women who have failed other treatments, or, when non-surgical options are contraindicated.

See the proposed harmonised hysterectomy for heavy menstrual bleeding policy.

Is there a proposed change?

No change.

This is a harmonised policy.

The proposed policy states:

  • The ICB will fund a surgical opinion and, if recommended, carpel tunnel release surgery when the following conditions are met:
    • There is uncertainty over the differential diagnosis.
    • The patient has rapidly progressive symptoms or signs of nerve damage (muscle wasting or permanent sensations in the distribution of the median nerve).
    • The patient has ongoing significant symptoms which have not been responsive to 12 weeks of conservative management, e.g. night splinting, corticosteroid injection. Symptoms may include:
      • Pain
      • Symptoms which are impacting on sleep
      • A permanent (ever present) sensation in the distribution of the median nerve
      • Disturbed sleep because of symptoms in the hand
      • Reduced functioning of the hand.
  • The ICB will fund revision surgery for incomplete release. Nerve Conduction Studies are recommended for consideration before surgery to predict positive surgical outcomes or where the diagnosis is uncertain and if there are other co-morbidities like Diabetes, Cervical radiculopathy, Neurological disorders, CVA/stroke etc. or recurrent disease.

See the proposed harmonised carpal tunnel policy.

Is there a proposed change?

No change to criteria for Dudley, Sandwell or Walsall. Reduced time for conservative management from 4 months to 12 weeks in Wolverhampton (in line with Dudley, Sandwell and Walsall).

Funding of revision surgery in incomplete release is new for all places ( positive impact).

This is a harmonised policy.

The proposed policy states:

Tonsillectomy for recurrent tonsillitis is funded if the following criteria are met:

  • sore throats are due to acute tonsillitis, and, the episodes are disabling and prevent normal functioning, and,
  • there has been seven or more, documented, clinically significant, adequately treated sore throats in the preceding year, or, there has been five or more documented episodes in each of the preceding two years, or, there has been three or more documented episodes in each of the preceding three years.

Tonsillectomy for recurrent tonsillitis will be funded at a lower threshold than that set out above, when recommended by a clinical specialist, for the management of individuals with the following conditions:

  • Acute and chronic renal disease resulting from acute bacterial tonsillitis.
  • Severe guttate psoriasis.
  • Metabolic disorders where periods of reduced oral intake could be dangerous to health.
  • PFAPA (Periodic fever, Apthous stomatitis, Pharyngitis, Cervical adenitis).
  • Severe immune deficiency that would make episodes of recurrent tonsillitis dangerous.

Tonsillectomy will be funded where tonsillectomy is part of a recognised care pathway for the management of other conditions, which include:

  • Obstructive sleep apnoea and sleep disordered breathing in children.
  • Cancer or suspected cancer
  • Recurrent quinsy (abscess next to tonsil)
  • Parapharyngeal abscess

See the proposed tonsillectomy policy.

Is there a proposed change?

No change. The harmonised policy makes the criteria clearer, especially the list of the conditions where tonsillectomy could be considered at a lower threshold if recommended by a specialist. The new policy specifies the definition of 'documented episode'. Sandwell has removed 6 months of watchful waiting.

This is a harmonised policy.

The proposed policy states:

Secondary care management of varicose veins (which includes endovenous thermal ablation, ultrasound guided foam sclerotherapy or open surgery (ligation and stripping) will be funded for the following:  

  1. Symptomatic changes or recurrent varicose veins
  2. Lower limb skin changes, such as pigmentation or eczema, thought to be caused by chronic venous insufficiency
  3. Superficial vein thrombophlebitis (characterised by the appearance of hard, painful veins)
  4. A venous leg ulcer (a break in the skin below the knee that has not healed within two weeks)
  5. A healed venous leg ulcer

See the proposed varicose veins interventions policy.

Is there a proposed change?

No change.

This is a harmonised policy.

The proposed policy states:

The ICB will fund surgical treatment when the disease has given rise to finger contractures causing loss of finger extension of 30° or more at the metacarpophalangeal joint or 20° at the proximal interphalangeal joint, or, severe thumb contractures that interfere with function.

See the proposed dupuytrens contracture policy.

Is there a proposed change?

No change.

This is a harmonised policy.

The proposed policy states:

Surgical release for trigger finger (or thumb) is commissioned where the following criteria are met:

  • The condition continues to cause pain or interferes with daily activities following a period of conservative management of up to 2 steroid injections. Splinting may be considered for up to 12 weeks, or, the finger becomes permanently locked, or, the patient has previously had 2 other trigger digits unsuccessfully treated with appropriate non-operative methods.
  • Treatment for a recurrence will not be automatically funded. Funding will be provided to the same criteria, as above.

See the proposed trigger finger policy.

Is there a proposed change?

No change.

This is a newly implemented policy for Dudley, Walsall and Wolverhampton.

The proposed policy states:

Vasectomy is commissioned in the following clinical circumstances:

  • The man has given informed documented consent:
    • for the permanent sterilisation procedure to be carried out
    • that he understands that reversal of sterilisation is not available on the NHS
    • that reversal of sterilisation has a poor success rate, and
    • of the requirement to have postoperative follow-up and post-procedure semen analysis.
  • Minimally invasive vasectomy is the first choice of procedure under local anaesthetic in a commissioned community clinic setting.
  • Vasectomy will be funded in an in-patient setting under general anaesthetic only in the following circumstances:
    • the patient is allergic to local anaesthetic, or
    • the patient is taking anticoagulants or antiplatelet medications and risk of haemorrhage (bleeding) is high, or
    • the patient has anatomic abnormalities, i.e. there is an inability to palpate and mobilize both vas deferens or large hydroceles or varicoceles, or
    • there is past trauma which has resulted in scarring of the scrotum which would require surgery in an in-patient setting.

See the proposed vasectomy policy.

Is there a proposed change?

No change for Sandwell residents/patients. This is a new policy for Dudley, Walsall and Wolverhampton which aligns with the existing policy criteria for Sandwell.

This is a harmonised policy.

The proposed policy states:

  • This procedure is not routinely commissioned for cosmetic reasons.
  • Exceptions are considered for patients with Crohn’s disease, only when recommended by the Inflammatory Bowel Disease multidisciplinary team. If surgery is required, this should be carried out by a colorectal surgeon specialising in Irritable Bowel Disease.

See the proposed anal skin tags removal policy.

Is there a proposed change?

No change.
 

This is a harmonised policy.

The proposed policy states that this procedure is not routinely commissioned by the ICB for cosmetic indications.

See the proposed tattoo removal policy.

Is there a proposed change?

No change.

This is a harmonised policy.

The proposed policy states that this procedure is not available on the NHS, and therefore it is not routinely commissioned by the ICB.

See the proposed reversal of female sterilisation policy.

Is there a proposed change?

No change.

This is a harmonised policy.

The proposed policy states:

The following clinical indications are routinely funded for:

  • hair removal for grafts and flaps either before or after reconstructive surgery if the recipient site either does not normally grow or the graft gives rise to a patch of excessive growth
  • part of the treatment for pilonidal sinuses to reduce recurrence.

Cosmetic and aesthetic (psychological) indications are not funded.

See the proposed hair removal policy.

Is there a proposed change?

No change

This is a harmonised policy.

The proposed policy states:

  • Surgery for snoring is not routinely commissioned. This includes, but is not restricted to, the following surgeries:
    • Uvulopalatopharyngoplasty (UPPP)
    • Laser-assisted uvulopalatoplasty (LAUP)
    • Palatal stiffening operations (CAPSO)
    • Radio-frequency ablation (Somnoplasty)
    • soft palate implants.

See the proposed surgery for snoring policy.

Is there a proposed change?

No change.

This is a harmonised policy.

The proposed policy states:

  • Botulinum toxin A is not commissioned for excessive sweating which is not responsive to other lifestyle and medical treatments.
  • Botulinum toxin A is not commissioned to treat excessive sweating for people with severe anxiety disorder, in accordance with the recommendation from the NICE.

See the proposed Botulinum A for excess sweating (hyperhidrosis) policy.

Is there a proposed change?

No change.

This is a harmonised policy.

The proposed policy states:

Reversal of male sterilisation is not routinely commissioned as NICE deems vasectomy to be a permanent method of contraception and it is considered irreversible.

See the proposed reversal of male sterilisation policy.

Is there a proposed change?

No change.

This is a harmonised policy.

The proposed policy states that this procedure is not routinely commissioned by the ICB for cosmetic and aesthetic (psychosocial) indications.

See the proposed Botulinum A for the enhancement of appearance policy.

Is there a proposed change?

No change.

This is a harmonised policy.

The proposed policy states:

The ICB does not routinely commission:

  • hair replacement systems
  • hair transplants
  • scalp reduction surgery.

Some indications are cosmetic/aesthetic (psychological) which the ICB does not routinely fund.

See the proposed alopecia-hair replacement policy.

Is there a proposed change?

No change.

This is a newly implemented policy for Wolverhampton.

The proposed policy states that this procedure is not routinely commissioned by the ICB for cosmetic indications.

See the proposed Spider Angiomas and veins policy.

Is there a proposed change?

No change for Dudley, Sandwell, and Walsall residents/patients. This is a new policy for Wolverhampton which aligns with the existing policy criteria for Dudley, Sandwell, and Walsall.

This is a harmonised policy.

The proposed policy states:

Skin resurfacing is not routinely commissioned for:

  • cosmetic and aesthetic (psychological) reasons
  • the treatment of acne or acne scarring.

See the proposed resurfacing policy.

Is there a proposed change?

No change.

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