Betsi Cadwaladr University Local Health Board ... - Health in Wales

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INDEX OF CONTENTS SECTION DESCRIPTION PAGE 1 Introduction & Definitions 3-5 2 Legal & Ethical Framework 5-8 3 Funding Application Procedures 9-14 4 Child Protection Issues 14 5 Entitlement of Patients to Treatment Overseas 15 6 Appeals Process 16-18 7 Audit, Monitoring and Review Arrangements 18 8 Communication Strategy 19-20 Appendix 1 Low Effectiveness Procedures (LEPs) 21 Appendix 2 Application Request Proforma 60 Appendix 3 IPC Panel Checklist 64 2
Section 1 - Introduction and Definitions 1.1 Betsi Cadwaladr University Local Health Board is responsible for the management of individual patient specialist requirements, not dealt with under the normal referral routes via primary or secondary care. Process and criteria must be consistently adopted and adhered to across the Local Health Board to facilitate decisions following requests made by appropriate clinicians and manage and monitor the individual cases. 1.2 The priorities for modernising the NHS should be underpinned by the careful management of overall NHS resources to ensure people have access to high quality services and care, regardless of where they live. Consequently, the Local Health Board needs to continuously improve the cost effectiveness of the services provided, thereby securing the greatest health gain from the resources available. In order to achieve this, funding decisions on individual patient services should be based on evidence of both the clinical effectiveness of services, together with an examination of the impact of specific high cost services or treatments on the wider ability to deliver care for the whole community. 1.3 Each case will be dependent on assessment of its own merits, in accordance with the criteria of the LHB. It is therefore necessary for the LHB to develop and maintain a clear, transparent and explicit mechanism to assist in the decision making process for these cases. 1.4 The mechanism in place must ensure that, where possible, decisions are made quickly to enable patients and referring clinicians to either implement proposals or find alternatives to requests where the application does not receive a positive outcome. However, the onus is on the referring clinician to ensure sufficient information regarding a particular request is made available to avoid unnecessary administrative delay. 1.5 This procedure presents the approach to be adopted by the Betsi Cadwaladr University Local Health Board in receiving and considering requests for funding of patient treatments/services that fall within the following categories: • Extra Contractual Referrals (ECR); • Non Contracted activity (NCA); • Named Patient Contracts (NPC); • Named Patient Variations (NPV) • Low Effectiveness Procedures (LEPs) • High Cost Drugs • Entitlement of Patients to Treatments Overseas 1.6 All these categories of treatments and services would be funded from current Local Health Board revenue and thus represent an in-year financial risk to the LHB. 1.7 Under the new proposals for the planning and commissioning of tertiary services, funding of specialist procedures previously managed by Health Commission Wales (HCW) will transfer to the LHB and be administered by the new national 3
Page 1: Betsi Cadwaladr University Local He
Page 5 and 6: consistent and appropriate. This wi
Page 7 and 8: The default position should be that
Page 9 and 10: Section 3 - Funding Application Pro
Page 11 and 12: efficacy; in doing so the Chief of
Page 13 and 14: 3.24 Any recommendation made by the
Page 15 and 16: A copy of the best practice guidanc
Page 17 and 18: 6.4 On receipt of this corresponden
Page 19 and 20: Section 8 - Communications Strategy
Page 21 and 22: APPENDIX 1 LOW EFFECTIVENESS PROCED
Page 23 and 24: OPCS Condition Criteria Source of a
Page 25 and 26: OPCS Condition Criteria Source of A
Page 41: OPCS Condition Criteria Source of A
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OPCS Condition Criteria Source of a
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6. Health Commission Wales. Cochlea
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Available at: http://www2.nphs.wale
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http://www.wales.nhs.uk/sites3/Docu
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Questions Comments / Explanation (m
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Questions Comments / Explanation (m
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Has the application been approved b
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Date of IPC Panel For LHB Use Only
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Betsi Cadwaladr University Local Health Board ... - Health in Wales

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