DHSC Clinical Commissioning

How the Department of Health and Social Care (DHSC) makes decisions about which treatments to fund

Introduction

The Department of Health and Social Care (DHSC) receives a fixed budget from the Treasury with which to fund all the health and social care required for the residents of the Isle of Man. It is not possible to fund all care and treatment that may be requested and hard decisions about the best and most effective use of resources have to be made. It is important that the process by which these decisions are made is clear, consistent and transparent.

Funding decisions on drugs, surgical procedures and other diagnostic or treatment technologies are published as 'Clinical Commissioning Policies.' The process by which these policies are agreed is described below.

Policy Approval Process

All Clinical Commissioning Policies are subject to the formal development and approval process outlined below.

Clinical Commissioning without groups

Clinical Recommendations Committee (CRC)

The CRC considers each intervention against the ethical framework and assesses the clinical and cost effectiveness of the intervention, the number of people in the population who would benefit from it, the impact it would have on their health and that of their carers/families and the likely cost of providing the intervention to all eligible patients.

The CRC has an annual work programme of topics for review and policy recommendation. Topics include a mix of review/updating existing polices and recommendations on new interventions. CRC considers topics where investment may be required and those which may offer opportunity for disinvestment and redeployment of resources (for example, where a long established intervention has been superseded by a more effective or cost effective one). Divisional managers, in conjunction with appropriate clinicians, can put forward topics for consideration/policy development using the topic consideration form below. Whilst clinicians are involved in the policy development process, we do not currently include the public or patient groups within the consultation arrangements.

CRC is a ‘single issue consideration’ committee and it does not hold a budget. It considers each intervention on its own merits but is not able to prioritise between interventions or on the basis of affordability within limited resources.

Policies are reviewed as indicated by changes in the evidence for clinical or cost effectiveness.

DHSC Finance/Commissioning Committee

The CRC provides policy recommendations to the Finance/Commissioning Committee. DHSC Finance/Commissioning Committee is to ensure that the DHSC budget is allocated to achieve the greatest improvement in health gain for the local population within available resources. This committee is able to take an overview of competing priorities and to confirm the availability of funding.

DHSC Departmental Meeting

The DHSC Departmental Meeting is the final phase of the process. This meeting includes senior managers from Health and Social Care, the Chief Executive Officer, Minister and Members..

Once a policy has been approved at this meeting it is authorised and ready for publication on the website.

Individual Funding Requests

The DHSC believes that the best and fairest way to fund and provide effective care for residents is through the development of clear care pathways and funding policies that allow equal access to all patients with similar clinical need.

However, the DHSC acknowledges that there will be occasions when the specific circumstances of individual patients warrant consideration for an intervention which is outside existing pathways and policies. Requests for such interventions may be made by clinicians, on behalf of their patients, to the Department of Health and Social Care through the Individual Funding Request (IFR) process.