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1 Insert heading depending Insert Interim Insert heading Clinical Commissioning depending on line on on Policy: line length; length; please please delete delete on line line Varicose length; please Veins delete delete other other cover cover options once once other cover options once you have chosen one. 20pt you Agreed: you have have November chosen one. one pt 20pt Ref: N/SC-035

2 Interim Clinical Commissioning Policy Varicose Veins First published: November 2013 Prepared by Armed Forces Commissioning Policy Task and Finish Group Published by NHS England in electronic format only Gateway Reference: 00610

3 Contents Policy Statement 4 Equality Statement... 4 Plain Language Summary Introduction Criteria for commissioning Evidence Base... 5

4 Policy Statement NHS England will commission treatments for Varicose Veins in accordance with the criteria outlined in this document In creating this policy NHS England has reviewed this clinical condition and the options for its treatment. It has considered the place of this treatment in current clinical practice, whether scientific research has shown the treatment to be of benefit to patients, (including how any benefit is balanced against possible risks) and whether its use represents the best use of NHS resources. This policy document outlines the arrangements for funding of this treatment for patients where NHS England directly commissions this service. Equality Statement NHS England has a duty to have regard to the need to reduce health inequalities in access to health services and health outcomes achieved as enshrined in the Health and Social Care Act NHS England is committed to ensuring equality of access and non-discrimination, irrespective of age, gender, disability (including learning disability), gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex (gender) or sexual orientation. In carrying out its functions, NHS England will have due regard to the different needs of protected equality groups, in line with the Equality Act This document is compliant with the NHS Constitution and the Human Rights Act This applies to all activities for which they are responsible, including policy development, review and implementation. Plain Language Summary Varicose veins are swollen and enlarged veins, usually blue or dark purple in colour. They may also be lumpy, bulging or twisted in appearance. They mostly occur in the legs.they are usually asymptomatic, but can be complicated by inflammation, skin changes including ulceration, rupture and bleeding as well as pain and discomfort. 1. Introduction Treatments for varicose veins are considered as procedures of low clinical priority and therefore not routinely funded by the Commissioner. Conservative management is the first line of treatment and applications will not normally be accepted without evidence that conservative management of asymptomatic and symptomatic varicose veins has been tried, and failed, for a period of at least six months. Prior to consideration for intervention patients should be given information regarding Weight loss if they have a raised BMI Light to moderate physical activity Avoiding factors which are known to make their symptoms worse if possible When and where to seek further medial help

5 2. Criteria for commissioning Interventional treatment of varicose veins will only be commissioned when one, or more, of the following clinical criteria are met in patient over the age of 18. a. Varicose eczema b. Lipodermatosclerosis or a venous ulcer (which has taken over two weeks to heal) c. A healed venous ulcer d. At least two episodes of documented superficial thrombophlebitis e. A major episode of bleeding from the varicosity. f. There is documented evidence that the patient is aware of the complications and limitations of the treatment Interventional treatment should be in line with NICE (1) guidance which identifies endothermal ablation as the first line intervention where suitable. The Clinician proposing this intervention is required to secure Prior Approval from the Armed Forces Commissioning or Health & Justice Commissioning Team in their area (Application form and contact details can be found on NHS Internet 3. Evidence Base (1) NICE clinical guidance 168 The diagnosis and management of varicose veins (July 2013)