Clinical Policy Alignment (formerly Difficult Decisions)

Clinical Policy Alignment (formerly Difficult Decisions)

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1 July 2022

In January 2020, the six NHS Staffordshire and Stoke-on-Trent clinical commissioning groups (CCGs) began the first phase of involvement about five areas of care:

  • Assisted conception
  • Hearing aids for non-complex hearing loss
  • Male and female sterilisation
  • Breast augmentation and reconstruction
  • Removal of excess skin following significant weight loss.

This work was known as Difficult Decisions. The policy criteria and patient eligibility were not the same across all the Staffordshire and Stoke-on-Trent regions. We wanted to make them the same for everyone. To do this, we wanted help from patients and the public in shaping the new policies for the five areas of care.

In the first phase of involvement, we received information through:

  • a survey (569 responses)
  • seven workshops
  • two further events held with Deafvibe and Action on Hearing Loss
  • correspondence.

This listening exercise ended on 1 March 2020. All the information and views were shared with the clinicians and staff who were working on the proposals for the five policies.

The report of findings can be found online:

Plans for further involvement were put on hold when all local health services focused on managing the COVID-19 (coronavirus) pandemic.

Involvement in autumn 2021

The pandemic response brought changes to the way the NHS delivered services and saw patients. We understood that this might have affected people’s feelings about services or changed their experience of them.

Our second phase of involvement took place between September and October 2021, when we ran an online survey (306 responses). The findings were passed to the clinicians and staff who were developing the proposals for the five policies.

The report of findings from the autumn 2021 involvement is available online:

The work of our reference group in spring 2022

To help with the next stage of work, we recruited local patients, stakeholders and members of the public to join a reference group.

At workshops on 4 and 22 March, the group reviewed and discussed the different proposals that we have been developing for the five areas of care.

In the first workshop, they agreed the desirable criteria for evaluating the proposals, and the weighting for the criteria.

In the second workshop, they discussed the new proposals for the five policies and procedures and evaluated them against the desirable criteria. The group also scored each proposal against each of the desirable criteria.

The report of findings for workshops 1 and 2 is available online:

Our work following the reference group

The information we gathered at the reference group workshops, along with the findings from our surveys and earlier events, was shared with the clinicians and managers working on the proposals. This helped them to refine the proposals.

We still have more work to do before our proposals can be finalised, but we will keep you informed as our work moves forward.

Clinical Policy Update September 2022

Staffordshire and Stoke-on-Trent Integrated Care Board (ICB) has agreed to harmonise the eligibility criteria for a number of treatments to ensure they are the same across the area, while following the latest clinical evidence and delivering the best use of NHS resources.

These changes are clinically led and not financially driven – in fact overall there will be an increased investment of around £70K to implement this.

On Thursday 22 September 2022 at the ICB Board meeting in Stafford, the ICB board agreed to implement changes to four of the policies, including removing eligibility criteria for adults with mild hearing loss.

The board also agreed that assisted conception should be separated from the wider clinical policy alignment work and that an interim policy for assisted conception should be developed whilst the ICB awaits further national guidance following the publication of the Women’s Health Strategy in July 2022.

Read more about the update here.

For more information, please see the page on our assisted conception involvement in March 2023