Research from the University of Reading is being used to create a fairer, more consistent and transparent system for assessing healthcare funding requests.

As we know, demand for healthcare exceeds the resources available to the NHS. This means that local health authorities (Clinical Commissioning Groups in England or Local Health Boards in Wales) are required to prioritise certain treatments over others. Hard choices in the NHS are unavoidable. This works at two levels.

At the community level, priority setting (or ‘rationing’ of health care) requires health authorities to have general policies describing their priorities for NHS funding. But the system is not only driven by a top-down system which pays no regard for individual need. That is why there is also a second level of decisions for individual patients who claim rights to treatments that are not normally funded by their health authority. It is at this second level that problems arise.

Clinicians can request treatments for their patients via an NHS individual funding request. In the past, doctors were asked to demonstrate that a patient’s ‘exceptional circumstances’ merited treatment not normally funded by the health authority. However, there was a problem defining ’exceptional’ – a term that has been understood in different ways by patients, clinicians and health authorities, leading to confusion and inconsistency of funding – and also a deep sense of unfairness.

Professor Chris Newdick was appointed to join a committee of inquiry in Wales to suggest how to improve this system for Local Health Boards. The committee made numerous recommendations, chief amongst which was that that the ‘exceptionality’ test be replaced with ‘significant clinical benefit’. This recommendation, which follows extensive research by Newdick into healthcare rationing, focuses on the probable clinical outcome of treatment, rather than an imprecise term about patients’ circumstances which caused so much difficulty.

All the committee’s recommendations were accepted and adopted in Wales. Newdick’s research led to key changes in policy for NHS Wales and has also been adopted by Clinical Commissioning Groups throughout the Thames Valley and elsewhere in England. As a result of making exceptionality the outcome rather than the decision-making principle, Newdick’s research is creating a fairer, more consistent and transparent system for assessing access to NHS treatment.

Find out more
View the full impact case study on the REF 2021 website: Reforming NHS Policy on Individual Patient Funding Requests