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Re: [IPk] Did anyone else receive a letter like this?

NICE are appraising pumps at this very moment, initial indications look
promising. However, all we have said is that NICE will be sending their
guidance to the NHS in April 2003.

Primary Care Trusts (PCTs) have replaced the old health authorities as the
local NHS management bodies. They are widely regarded as the government's
flagship initiative for improving the NHS. The first PCTs were established
in April 2000. There are now over 300 PCTs covering the whole of England.
They control 50% of the total NHS budget. By 2004, they will control 75% of
the budget. Scotland, Wales and Northern Ireland have slightly different

In the meantime keep pushing for the funding from your Primary Care Trust
who will ultimately provide the funding. be it from the hospital via their
NHS Trust or any other body.

Government policy is as follows:


The official policy from the Department of Health states:

"Although pumps are not in wide use across the country, if resources allow,
hospital consultants may prescribe insulin pumps as part of NHS treatment."

The funding of an insulin pump and its associated supplies should,
therefore, be obtained from the relevant Primary Care Trust or Primary Care
Group. Certain criteria have to be met and the full support of the Diabetes
Team is essential.

Local Health Authorities have told us that:

"Treatment funding is normally left to the individual consultant to decide.
If pump therapy is decided as the best course of action, this should be
paid for from within the Health Authority's Service Level Agreement that
has been agreed with the provider (the hospital at which the patient
requiring the treatment attends). The SLA is adjusted each year to account
for new treatment options and areas that may be over or under-funded.

A consultant may request funding for several patients, if so, this area may
be seen to be over performing (i.e., this treatment option is required by
patients), then money would be removed from under-performing areas who
have more than they require to provide their service. If an area is
GPs and consultants may be asked to cease referrals for patients requiring
expensive treatments. In theory, if more money needs to be spent it should
made available through the SLA rather than patients no longer being

It is the responsibility of the Diabetologist to bid for the cost pressure
of insulin
pump therapy as a necessary clinical need for individual patients. Finance
will be decided as a cost pressure by the Health Authority if Diabetologists
push for this treatment."

>From the patients point of view they must obtain the backing of their
diabetes team and/or their GP before making an application. The diabetes
team must support the request in writing, stating the reasons why the pump
will be beneficial. Our experience has shown that funding is assessed "on
the grounds of clinical need", more than for any other reason.

The patient must be prepared to show that they have been doing their best to
control their own diabetes. Patients using pumps are expected to do at least
four blood sugar tests a day and keep these recorded. This is necessary to
show that the pump is providing the amount of insulin needed at various
times in the day (and occasionally during the night) enabling them to take
remedial action if required, thus giving them control of their diabetes.

A detailed log of their control prior to starting pump therapy is good
evidence of their requirement for this treatment. This should include
insulin dosages, levels of HbA1c, number of hypo's, any ketones in the
urine, days off sick, hospital visits, hospitalisation and so on.  Any
complications, medical or social problems should also be stated.

Lobbying of their MP by the patient will prioritise the case of insulin pump
therapy with the Health Authority or Primary Care Trust. When raised by the
MP, the patient's case will become more urgent as a result.

Further information can be obtained from us.

John Davis
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