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
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.
Commissioning for Individuals
It is expected that existing contracts with NHS provider services (universal & specialist) across Derby & Derbyshire Footprint are able to meet our populations health needs however should the need for bespoke provision be identified specific personalised commissioning arrangements will be made.
The ICB has a Commissioning for Individuals process which includes Continuing Healthcare and Continuing Care for Children and Young people but also includes consideration of funding requests where assessed health care needs cannot be met by existing NHS commissioned services.
This includes (be not exhaustively):
- Individuals (Adults and Children) with an acquired brain injury, complex neurological and/or spinal injury who do not sit within NHS England specialist rehabilitation pathway or any other commissioned pathway and require ongoing non-acute rehabilitation care.
- Emergency funding as part of Care & Treatment review (CTR) or Care, Education & Treatment Review (CETR – Children & Young People) for individuals with a Learning Disability and or Autism who have been admitted to a mental health hospital or for individuals who are at risk of hospital admission.
- Emergency funding as part Local Area Emergency Protocol (LAEP) meetings. Some people with learning disabilities or autism also have mental health needs. Most people are supported at home and do not need to be admitted to or stay in a specialist hospital. LAEP meetings can stop people needing to go to a specialist hospital. Sometimes support needs to change quickly. This means there’s no time to have a Care and Treatment Review so an LAEP will be held instead.
- Section 17 (MHA 1983/2007) Leave funding agreements. This is funding to support individuals who are detained in hospital under the Mental Health Act if they are granted leave of absence by their responsible clinician. This might be for a specific occasion or where the clinical team wish to see how the individual manages outside hospital before making a decision to discharge from hospital inpatient care.
- Alternative Hospital Placement for individuals with a primary diagnosis of mental illness, learning disability and/or autism.
- Specialist/bespoke Equipment not within current commissioned arrangements. An assessment will be undertaken by professionals managing the healthcare needs of the individual. Where an equipment need is identified the professional undertaking the assessment will apply for funding from the NHS.
- Specialist Assessments or therapeutic interventions (not commissioned locally through existing contracts) where the individual’s NHS clinician considers that the individual has an assessed need for the specialist assessment or intervention.
- EHCP needs assessment and EHCP annual review – if health professionals involved assess that they are unable to meet a child/young person’s health care need through locally offered NHS commissioned services (universal and specialist). The Childrens Commissioning team are the point of contact for the Local authorities, health professionals or educational settings seeking advice and can be contacted via firstname.lastname@example.org. Enquiries from parents, carers and young people can be made via email@example.com.
- Section 117 aftercare – individuals (Adults & Children) are entitled to section 117 aftercare if they have been in hospital under section 3, 37,45A, 47 or 48 of the Mental Health Act 1983 and if they are placed on a Community Treatment Order (section 17A) after discharge from hospital. The NHS and social services will provide individuals section 117 aftercare services providing support or services linked to the individuals’ mental disorder. There are panel arrangements whereby the Local Authority and the ICB will agree what funding is required to meet individuals’ aftercare needs.
- Personal Health Budgets – A PHB is an amount of money that is given to a person receiving certain NHS care, to allow them to pay for the help and support they need. The allocation of this budget is agreed between the person (or their representative) and their local NHS team. A PHB is based upon a detailed care and support plan, which identifies the health and wellbeing needs of the individual and specifies outcomes that demonstrate how these needs have been met.
- Joint funding with the Local Authority for Children & Young with health care needs that cannot be met by commissioned services or do not meet eligibility for Continuing Care. Joint arrangements are most frequently initiated by social services but can be initiated from health or the professional who knows the representatives are core members of multi-disciplinary teams where a child has complex needs including health needs which is beyond the scope of what commissioned services can offer. They have the responsibility to resource additional support required to meet identified health needs. (Sec. 3 NHS Act 2006).child best. Joint arrangements are needed when a child has needs across health, social care and often education that cannot be met by other commissioned means.
- Joint funding with the Local Authority for Adults and Children with Learning disabilities and/or Autism
Health professionals seeking funding via the Commissioning for Individuals route can contact the team for advice at: firstname.lastname@example.org
The ICB has a statutory duty to ensure health care provision is accessible, evidence based and cost effective. All requests for funding are reviewed in terms of the requirement to meet the assessed need and must demonstrate sound clinical evidence from an NHS assured provider.
Local and National policy will be utilised in the decisions making process and all outcomes clearly documented. All decisions made are transparent, fair, equitable and open to scrutiny.