A new 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 publically 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.
The report recommends and is working to provide:
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.
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.
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.
A review of international national registries in order to determine best practice from countries which already have a registry in place.
A national NHS England strategy to reduce regional variation in access to inguinal hernia procedures.