57% of CCGs in England have policies in place that restrict patient access to hernia repair

A report by the Royal College of Surgeons (RCS) and the British Hernia Society (BHS) published in July 2018 has shown that, despite the effectiveness of inguinal hernia surgery, Clinical Commissioning Groups (CCGs) are restricting access to treatment on the basis of unreliable Patient Reported Outcomes Measures (PROMs) data. 

The report's results show significant regional variation in access to surgery. Eight CCGs even require patients to demonstrate a history of incarceration and/or their hernia increasing in size from month to month before being able to access surgery.

The Hernia Outcomes Campaign (HOC) is happy to see that the RCS and the BHS are raising awareness of this worrying trend. In a similar vein to the issues recently outlined by both organisations, the HOC’s latest report entitled Inguinal Hernia Surgery: Patient Outcomes and Reducing Variation found that over half (54%) of CCGs with publicly available guidance have reduced access to inguinal hernia repair. Patient access restriction has led to unacceptable regional variation and sets a worrying precedent for NHS England rationing procedures without appropriate assessment of clinical outcomes. The HOC's report is referenced in the RCS and BHS's report.

The HOC is delighted to see that different bodies are working towards the same goal in trying to overturn these restrictions, and hopes to see major changes in the way commissioning decisisons are made.

You can access the report here


New Hernia Outcomes Campaign report highlights CCGs restricting access to hernia surgery based on flawed data

A 2017 report by the Hernia Outcomes Campaign shows that:

  • Over a third (31%) of all Clinical Commissioning Groups are reducing access to hernia surgery.
  • Over half (54%) of CCGs with publicly available guidance have reduced access to inguinal hernia repair.
  • Decisions often made on the back of flawed PROMs data.
  • Patient access restriction has led to unacceptable regional variation and sets worrying precedent for NHS England rationing procedures without appropriate assessment of clinical outcomes.

The Hernia Outcomes Campaign has undertaken an audit of the 207 Clinical Commissioning Groups in England and found that, of the 120 CCGs that have publicly available commissioning guidance, 65 have adopted a "watchful waiting" approach to commissioning inguinal hernia procedures. The NHS perceives inguinal hernia surgery to be a procedure of limited clinical value based on PROMs data which is not fit for purpose. As a result of which, they are enforcing decisions to limit access to this kind of surgery. 

In September 2017 NHS England acknowledged that the Patient Reported Outcome Measure (PROM) for groin hernia was not capturing the relevant information needed to determine genuine patient outcomes. 

The report, which was finalised before the publication of NHS England’s decision to remove the groin hernia PROM collection, argues that a new form of data capture is needed to prevent CCGs from making commissioning decisions arbitrarily and without the correct evidence base. CCGs should not be restricting access to surgery based on inadequate, or no data.

The report also notes that:

  • Inguinal hernia surgery is the most common surgical procedure for men above the age of 18, with more than 80,000 procedures performed each year.
  • Around 98% of inguinal hernias are found in men because of the vulnerability of the male abdomen to the formation of hernias in this region.
  • To arbitrarily restrict access to this procedure is to deny many patients access to potentially life changing surgery.  


  1. The amendment of the PROMs questionnaire for groin hernia to ensure it captures appropriate patient outcomes data in order to determine the clinical effectiveness of the procedure.
  2. CCGs to routinely commission inguinal hernia repair, rather than adopting a “watchful waiting” approach, until robust long term data is collected which allows NHS England to make an informed decision on the clinical effectiveness of the procedure
  3. The development of a national registry on hernias – including inguinal hernias – to ensure comprehensive data capture and bring the United Kingdom in line with other European countries. This should be a mandatory requirement for all surgeons who perform this procedure and should be adequately funded.
  4. A review of international national registries in order to determine best practice from countries which already have a registry in place.
  5. A national NHS England strategy to reduce regional variation in access to inguinal hernia procedures.

Notes to editors:

The Hernia Outcomes Campaign is led by a country-wide group of surgeons who specialise in hernia repair. The aim of the campaign is to improve outcomes for hernia patients by increasing access to appropriate treatment and challenging non-evidenced-based commissioning decisions. The Campaign shares industry connections with Bard Limited. 




Guardian: Number of NHS patients waiting over six months for surgery up 40%

In a Guardian article published on 9th November, they note that according to analysis by the Royal College of Surgeons the number of patients waiting more than six months for surgery in England was 40% higher in September than the same month last year. Furthermore, the 151,710 people waiting more than six months for hip or knee replacements, cataract removal, hernia repair and other non-urgent operations in September was also 5% up on August.

The RCS analysis of NHS performance data, released on Thursday, also found that 21,033 patients were waiting at least nine months for surgery, 59% up on September last year.

Commenting on the latest figures, RCS’s president, Prof Derek Alderson, said: “It is clear that the NHS is under mounting pressure. Waiting several months for treatment could have a serious impact on a patient’s quality of life and the effectiveness of their eventual surgery.

“What is most concerning is this rise comes before pressures on the NHS are expected to increase this winter. With bed capacity expected to be at a premiumdue to continuing issues with social care, some patients needing non-urgent surgery this winter simply will not enter an operating theatre until the spring.”

Read the original article here

National Patient Reported Outcome Measures (PROMs) Programme Consultation Report

NHS England carried out a consultation to understand how the National PROMs Programme is currently working, and how it should be developed in the future. The consultation ran on the NHS England website from 4 January to 28 March 2016. 119 responses were received in total from a range of types of stakeholder: researchers and academics, clinicians, patients, members of the public, and representatives of charities, professional bodies, CCGs, NHS trusts, independent sector care providers and private sector suppliers of PROMs data services.

Following this consultation, NHS England has taken the decision to discontinue the mandatory varicose vein surgery and groin-hernia surgery national PROM collections. Along with the evidence found in the consultation, the rationale for this decision is based on multiple factors:

  • surgical treatment of varicose veins is currently much less frequent and the condition is usually not a major cause of patient debility;
  • groin hernia surgery is offered mainly to reduce the risk of requiring emergency surgery, rather than to relieve symptoms, which are often relatively minimal. This, along with the fact that there is no condition-specific PROM for groin-hernia surgery, means that the existing PROM has limited value.

Further information can be found here