The Patient Perspective Ms Ginette Camps-Walsh

1. The Patient PerspectiveMs Ginette Camps-Walsh Working in partnership with

2. Improving Interventional Radiology: The need for action www.femisa.org.uk Ginette Camps-Walsh FEmISA

3. UFE- MY FIBROIDS! • AFTER UFE • Uterus normal size - much slimmer • Kidney normal size • Bulk symptoms gone • Overall improvement in health • Feel younger! – playing squash • Would have UFE again • Recommended to many • No early menopause • BEFORE • Uterus 34 weeks - looked pregnant • 4 large fibroids • Enlarged kidney • Heavy & prolonged menstrual bleeding

4. BENEFITS OF EMBOLISATION Clinical Benefits • Lower mortality than hysterectomy • No surgery, no general anaesthetic, quicker recovery • No possibility of surgical trauma • No haemorrhage, no scars, small incision site • Fewer long-term side effects c.f. hysterectomy - early menopause, prolonged early HRT use, sexual dysfunction, clinical depression, urinary incontinence, vaginal or posterior prolapse, later adhesions • Uterus still intact, maintain fertility & sexual function • Possible to have successful pregnancy Ginette Camps-Walsh FEmISA

5. BENEFITS OF EMBOLISATION Social Benefits • Overnight hospital stay versus 5-10 days for hysterectomy • Little at home nursing care required • Return to work in 1-2 weeks versus 3 months for surgery • No restriction to lifting or driving • Reduced likelihood of early menopause • Less likelihood of corrective surgery • Maintain fertility & femininity – important to women • Sexual function normally unaffected • Possible to have successful pregnancy Ginette Camps-Walsh FEmISA

6. BENEFITS OF EMBOLISATION Cost to Patients, their families • 1 night hospital stay vs. 5-10 days hysterectomy • Return to work 1-2 weeks vs. 3 months • Little if any need for care from family • No restriction on driving and lifting • Less need for early HRT Cost to NHS • 1 night stay vs. 5-10 days – freeing resources • UFE less expensive than surgery • Less early HRT etc Ginette Camps-Walsh FEmISA

7. ECONOMIC BENEFITS Potential Theoretical Savings if all Hysterectomies for Fibroids were replaced by UFE • NHS Savings PbR Tariff £19,367,441 • Saving Hospital Bed Days 77,355 • Savings on working days * 1,137,570 • Economic savings * £100,788,702.00 *Return to work 2 weeks UFE vs. 3 months hysterectomy Ginette Camps-Walsh FEmISA

8. SERIOUS EQUITY ISSUES WITH UFE Access to UFE – • Confined in the main to assertive, educated women from higher socioeconomic groups • Women from lower socioeconomic groups could arguably benefit more from UFE Clinical Equity for women and men – • Prostatectomy normally confined to cancer treatment • Hysterectomy used inappropriately for many minor gynae problems Shouldn’t such invasive surgery should be confined to cancer treatment? Ginette Camps-Walsh FEmISA

9. BARRIERS TO ACCESS FOR UFE The NHS Referral System! • Many women are not informed of alternatives to hysterectomy [contrary to NICE & GMC guidelines & NHS white paper] • There is a lack knowledge about UFE & centres offering it • Comparative information on hysterectomy vs. UFE often inaccurate and biased Women are often not given a choice • IRs and gynaecologists should be working together as a team – this is happening • Hysterectomy is second commonest operation in the private sector Ginette Camps-Walsh FEmISA

10. BARRIERS TO ACCESS FOR UFE Knowledge and Education • NICE guidelines on Heavy Menstrual Bleeding state - women must be offered UFE, hysterectomy and myomectomy – but many are not • Most GPs are unaware of UFE - unable to advise women • Women are not being informed about comparative morbidity & mortality of fibroid treatment objectively, if at all – uninformed patients do not have a choice • Commissioners are unaware of UFE and do not commission it • Commissioners may feel NICE clinical guidelines are expensive • Some PCTs refuse to fund local UFE, although it is cheaper Huge health inequalities – the educated find out for themselves Ginette Camps-Walsh FEmISA

11. BARRIERS TO ACCESS FOR UFE NHS Procedural Issues • Patients cannot be referred directly to interventional radiologists or use Choose and Book • No proper OPCS codes for UFE so – • No proper PbR tariff • PbR tariffs encourage old invasive treatments e.g. hysterectomy because they pay more • NICE Technology Appraisals commissioning is mandatory, but clinical guidelines and interventional procedures reviews are not • NICE does not consider costs to patients, their families, employers and society – Freddie Earl Howe would like this to change Ginette Camps-Walsh FEmISA

12. HOW TO IMPROVE ACCESS TO UFE Impetus from on High (DH/Ministers) to – • Ensure every Trust fully informs all patients objectively of all treatment options - audited through PROMS • Sort out proper OPCS codes for UFE and all IR procedures • Change PbR tariffs so less invasive new medical technologies are more profitablefor Trusts • Allow direct access to IRs & through Choose & Book • Set up an education system for GPs and commissioners to ensure they are informed & aware of new medical technologies and IR procedures and commission them 6. Change NICE’s remit to include patient & societal costs and reform medical technology reviews 7. Ensure sufficient NHS resources to meet patient demand. Ginette Camps-Walsh FEmISA