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The role of the Integrated Care Board is to allocate the NHS budget and commission services to meet all the reasonable health requirements of its resident population, taking over the functions previously held by the clinical commissioning group (CCG) and some of the direct commissioning functions of NHS England.
In most cases commissioned services will be provided by Primary Care (General Practices), local NHS acute hospitals and NHS community services and other providers who have NHS existing contracts (universal & specialist).
However, the ICB, in meeting its responsibility to commission health services for the population of Derby and Derbyshire sometimes commissions care that is not provided as part of existing commissioned service. This might, for example, include packages of care, interventions, assessments or treatments or placements for individuals on a case by case/individual basis.
Routes to NHS funding where existing commissioned services are unable to meet needs are outlined below:
NHS Continuing Healthcare (CHC) & NHS Continuing Care for Children & Young People
Many individualised packages of care are provided through the National Framework for Continuing Healthcare or National Framework for Children and Young Peoples continuing care.
NHS Continuing Healthcare means a package of ongoing care that is arranged and funded solely by the NHS specifically for the relatively small number of individuals (with high levels of need) who are found to have a ‘Primary Health Need’ (see more in Primary Health Need section below). Such care is provided to an individual aged 18 or over to meet health and associated social care needs that have arisen as a result of disability, accident or illness.
Continuing Care is for Children and young people (0-17) who have complex health needs that have arisen as a result of disability, accident or illness, who may require additional support that cannot be met by existing NHS universal and specialist health services. This additional support is assessed and agreed via the Continuing Care Assessment process and the care is then delivered through a tailor-made commissioned package of care.
Individual Funding Request
The NHS looks to provide care for all patients but there are some treatments that are not normally available on the NHS. An individual funding request (IFR) is a request for NHS funding for treatment that is not normally available and one which is only paid for under certain circumstances.
The NHS has limited resources and we have a duty to manage them carefully. This means we have to:
- look at the clinical reasons for exceptionalism in individual cases
- look at evidence for the safety and effectiveness of any treatment
- ensure that the services we pay for will give patients the greatest health gains from the resources we have.
The IFR process is clinically led. This means that a patient will need the support of a clinician (usually the patient’s GP or hospital consultant) to make a case on their behalf and only if the clinician considers there to be clinical grounds for the request.
Complex Care, Governance & Assurance (CCGA)
It is expected that existing contracts with NHS provider services (universal & specialist) across the Derby & Derbyshire Footprint can meet our populations health needs, however it is understood on rare occasion that this may not be the case. An NHS healthcare professional may identify the need for bespoke healthcare provision and can refer to the CCGA team for consideration in these circumstances.
The NHS has limited resources and we have a duty to manage them carefully. This means we must:
- Ensure that the bespoke request cannot be met by NHS commissioned services and does not contravene any national or local NHS policies on what can be provided via the NHS.
- Review the clinical reasons for the bespoke request which includes checking current NICE Guidelines.
- Consider evidence for the safety and effectiveness of any treatment requested.
- Ensure any request meets the NHS values of fairness, equity and best value.
The CCGA process is clinically led. This means that a patient will need the support of an NHS healthcare professional to make a case on their behalf. The request is screened and will only progress to CCGA decision panel if the case meets all the screening criteria.