NHS operations and prescriptions reviewed across the North West of England.

A hospital worker on a ward Image copyright PA
Image caption Clinical Commissioning Groups are holding consultations until the end of January

Operations from cosmetic surgery to Caesarean sections could be more heavily rationed by NHS bosses across the North West in a bid to save money.

Planned C-sections in Lancashire and cosmetic procedures such as tattoo removal in Wirral are under review.

Clinical Commissioning Groups (CCGs) in Cheshire and Wirral are consulting the public until 17 January as they produce plans to save nearly £44m.

CCGs have been tasked with achieving a 1% surplus on their budget every year.

In Lancashire all eight CCGs are reviewing treatments such as:

  • Reversal of sterilisation
  • Treatment of varicose veins
  • Planned C-sections
  • Some knee and hip procedures
  • Tonsillectomy

Wirral, East Cheshire and West Cheshire are in a group of CCGs proposing to raise the threshold before minor operations can go ahead.

These include:

  • Treatments for some skin conditions
  • Ear, nose and throat procedures
  • IVF and sterilisation treatments
  • Surgery for injuries and conditions affecting bones, joints, ligaments, tendons, muscles and nerves
  • Services relating to the urinary tract, reproductive organs and incontinence
Image copyright PA
Image caption NHS Bolton CCG has finished a consultation on over-the-counter products

Not all CCGs in Lancashire face a deficit in the next financial year and a statement from the group explained that the consultation is also related to "harmonising" services.

It added: "For some services there may well be a change in the service provided or that a service is no longer provided at all on the NHS due to its low clinical value and prioritisation of resources."

Bosses at Wirral, which faces a £9m deficit for 2016-17, said in some cases a threshold could be introduced before treatments are provided.

It said other procedures "would no longer be routinely funded and some would end".

In Greater Manchester, there is currently no review of operations but NHS Bolton CCG has finished a consultation on over-the-counter products.

Meanwhile NHS Bury CCG will not be funding gluten-free products from January.

Image caption Most specialist fertility treatments, such as IVF, will no longer be available on the NHS in Mid Essex

Analysis: Gill Dummigan, BBC North West health correspondent

As we get older we typically need more healthcare.

As the population as a whole gets older, this puts a huge strain on the NHS, as does diabetes and other chronic conditions linked to lifestyle.

NHS funding has struggled to keep pace so a lot of CCGs are facing big deficits next year.

Now legally obliged to balance the books, it is no longer enough for them to make efficiency savings alone.

So they want to hear your priorities and are running consultations on limiting or stopping access to various medical products and procedures.

The background to this is that while nine out of 10 prescriptions are free to the patient, the NHS picks up the whole tab.

At the moment some products like paracetamol, are prescribed even when they are much cheaper to buy at your local chemist or supermarket.

Following consultation, a number of CCGs in the region have now stopped prescribing over-the-counter medicines for short-term conditions.

A more controversial topic is restricting access to medical procedures.

The NHS defines some treatments as "Procedures of Limited Clinical Value". Essentially, not getting them won't be life-threatening, but it might make it much less pleasant.

IVF is a prime example - you might be offered fewer rounds of treatment for example. Or the eligible age range may be reduced.

Another is knee replacements - there might be a higher pain threshold to qualify for them.

It's not a conversation anyone's looking forward to having. But with the money available, the CCGs say it's unavoidable.

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