Clinical Policy Alignment 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.

Since January 2020, the NHS commissioners in Staffordshire and Stoke-on-Trent have been reviewing the eligibility criteria for five procedures:

• assisted conception
• hearing loss in adults
• male and female sterilisation
• breast augmentation and reconstruction
• removal of excess skin following weight loss.

This was called ‘Difficult Decisions’ and is now known as the programme for Clinical Policy Alignment. During the past two years work has been undertaken with the public, patients, clinicians and other stakeholders to shape proposals that will inform the future commissioning policy for each of the five clinical areas.

During the life of the programme, there have been several public involvement and listening events as well as a robust options appraisal process where the former clinical commissioning groups (CCGs) held several technical events to develop and review the proposals. Clinical leads, Quality leads, Public Health specialists and locality leads were involved in these events, supporting the wider project team with the evaluation.

On Thursday 22 September 2022 at the Integrated Care 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.

The ICB will now develop plans for the implementation of these policies and will continue discussions with Overview and Scrutiny Committees and other stakeholders.

Here is a summary of the proposals and impacts:

Assisted conception

To decouple assisted conception from the wider policy alignment programme and develop an interim aligned assisted conception policy pending further national guidance next year.

Hearing loss in adults

To commission hearing aids with no eligibility criteria.

Impact: Removal of current restrictions for mild hearing loss in North Staffordshire.

Male and female sterilisation

Female sterilisation will be routinely funded for contraception when unable to tolerate other contraceptives OR there is absolute clinical contraindication to pregnancy.

Impact: Equal impact across all areas as currently no criteria in place

No amendment to vasectomies (male sterilisation) is proposed. They will continue to be undertaken in the community and will only be undertaken in an acute setting where there is a clear clinical indication. 

Breast augmentation and reconstruction

Will be routinely funded following mastectomies carried out due to suspected or proven cancer OR following double mastectomies for cancer prevention in high-risk cases.

Impact:

• An improvement on the policy for the five areas that only offer post-mastectomy reconstruction in the affected breast
• A reduced offer for North Staffordshire and Stoke-on-Trent who currently offer reconstruction due to burns as well as for post-mastectomy
• A reduced offer for Stoke-on-Trent who currently offer breast augmentation for developmental failure and significant asymmetry.

Removal of excess skin following significant weight loss

Abdominoplasty / apronectomy and body contouring will not be commissioned.

Impact:

• A reduced offer for the five areas who currently commission abdominoplasty/apronectomy against criteria
• A reduced offer for Stoke-on-Trent who currently commission body contouring against criteria.