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Individual Funding Requests

An Individual Funding Request (IFR) is a request to fund healthcare for an individual who falls outside the range of services and treatments that NHS St Helens Clinical Commissioning Group (CCG) has agreed to commission.

An IFR is only regarded as such when a case can be set out by a patient’s clinicians that they have exceptional clinical circumstances.  Below is the definition of exceptionality as detailed in the Individual Funding Requests for Clinical Interventions Policy.  Defining Exceptionality

  • The patient is significantly different to the general population of patients with the condition in question

and

  • The patient is likely to gain significantly more benefit from intervention than might normally be expected for patients with that condition

Source: Dr Henrietta Ewart The following information explains how NHS St Helens CCG makes decisions about providing treatments that are not normally available through the National Health Service (NHS).

Like any other organisation, the NHS has limited resources and we have a duty to manage them to a robust process.

This means we have to:

  • 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 finite resources we have available.

There are a set of recognised principles which are used in the NHS to guide commissioning decisions on individual treatments.  There are some treatments that are not routinely funded and as such we have policies on particular drugs or treatments.  These clinical commissioning policies are agreed with other Clinical Commissioning Groups in Cheshire and Merseyside, are reviewed regularly and are available on our website shortly.

The IFR Team will validate requests in line with NHS St Helen CCG’s commissioning policies.

Information we receive about you will be treated in the strictest confidence and used according to the data-protection laws.

The IFR Team will consider whether your case meets our policy criteria and will make a decision.  However, your case may need to be discussed by NHS St Helens CCG’s Individual Funding Panel who meet regularly.  The panel consists of representatives from the IFR Team who will present your case as well as clinicians and senior managers.

There are times when an IFR may be refused and this is always a difficult situation.  A detailed response on the reason for the decision will be provided including the criteria considered by the NHS St Helens CCG.

Stages of our decision-making process

We receive a letter from your clinician requesting treatment for you

  1. The IFR Team will screen it against NHS St Helens CCG’s local policies and a decision will be made.  If a decision cannot be made, your request will be reviewed by the IFR’s triage team which is made up of clinicians.
  2. If the triage team cannot make a decision, further information may be requested.
  3. On receipt of further information requested the triage team will then review this request again and make a decision if possible.
  4. If the triage team cannot make a decision, your request will be considered by the CCG’s Individual Funding Panel.

If you think we have not followed the correct process to reach our decision, or you feel we did not consider everything relevant when we made our decision, your referring clinician can appeal by writing to say why.

How we make our decisions

NHS St Helens CCG Individual Funding Panel makes its decision on whether to fund new technologies and medicines by assessing the clinical effectiveness of treatments (do they work and what are the benefits when compared with existing treatments?) and their cost effectiveness. Where there are significant financial implications for the CCG but proven health benefits, the final decision rests with the Governing Body of the CCG. The panel also receives requests from health professionals to fund a treatment that is not normally commissioned by the CCG.  If the request could apply to a number of patients, the decision is referred to NHS St Helens CCG to consider the development of a relevant policy.  Otherwise, the decision the panel needs to make is whether the patient is clinically exceptional to our policy (as defined above) and whether it is fair and equitable to offer this treatment to one individual when it is not routinely available to others.

How to make a request for funding

IFRs are dealt with by Midlands and Lancashire Commissioning Support Unit who provide the service on behalf of NHS St Helens CCG.

Patients are unable to submit IFRs.  However, if your clinician believes that your case is clinically exceptional then they can submit a request (and all relevant clinical information to support your application) using the relevant IFR form which can be accessed on the links below.  

This should be submitted to the IFR Team whose contact details are as follows: Individual Funding Request Team NHS St Helens CCG  Midlands and Lancashire Commissioning Support Unit  1829 Building Countess of Chester Health Park Liverpool Road Chester CH2 1HJ

Email ifr.manager@nhs.net Telephone: 01244 385016 or Fax: 01244 470380