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[IPk] (Long) Pump funding (lack thereof) in/around Oxford


I won't say much about a child's control being considered 'too good for a 
pump' when HbA1c is 8.6 because I know that a maelstrom of outraged e-mails 
is about to hit the listserv!

I will comment, however, on the sneaky, lousy things that the PCTs in 
Oxfordshire have been up to because both Michelle and I have been affected. 
Michelle and I were profiled in a news segment for ITV Central over the 
summer: Michelle because she needs a pump and has been unable to obtain 
funding despite fitting every criterion known to man, woman, or beast; and I 
because I have a pump but the PCT has not put up money for my supplies, 
despite having acknowledged in print that it should be paying for my stuff 
according to the Department of Health's NICE Guidance implementation advice 
of July 2003. Michelle got given a lot of very creative--even 
ingenious--excuses for why she could not have a pump before the NICE 
guidance came out, but that's her story to tell!

In both of our cases, since summertime the buck has been passed rather 
stealthily. I post the following process analysis for the benefit of 
everyone who lives in a PCT structured like Oxford's PCTs are (I have heard 
that there are others in the country who are acting similarly):

1) Patient fits NICE criteria for pump funding
2) Patient gets letters of support from GP and diabetologist, and writes 
own, according to NICE guidelines
3) PCT receives packet of letters
4) PCT waits at least a couple of months to make a 'decision' on the 
5) PCT says it doesn't have to pay because it's been given until 15 Feb 04 
and 'we haven't any room in this year's budget'.
6) Patient is forced either to fund personally or to continue feeling unwell 
and developing complications

If the patient--let's call her Melissa--already has a pump, the saga may 
6) Patient replies--having submitted formal pump funding application in 
early June--in early August, 'But I already have a pump. Do you receive 
correspondence from NICE and the Dept. of Health?' PCT: 'Yes'. Patient: 'Do 
you read it?' PCT: 'Sometimes...can you send me a copy of what you're 
talking about? I've never heard of it'.
7) At patient's request, GP sends documents to PCT in first week of August
8) 6 weeks later, PCT says responsibility to prescribe consumables rests 
with patient's specialist centre.
9) Patient contacts diabetologist in mid-September and asks, 'Will you 
please prescribe my consumables? This letter says that if your doing so 
"leads to a funding issue", the funding will be commissioned'.
10) Diabetologist says, 'No, it's not that simple', in late September.
11) Patient loses it and asks for the truth.
11a) Truth: in this PCT to prescribe something means to pay for it. The 
Oxford Centre for Diabetes, Endocrine and Metabolism receives no prescribing 
budget so refers all prescriptions back to GPs. But GPs are not charged with 
responsibility to fund pump therapy AND the specialist centre has no money 
to do so.
12) In mid-October, the PCT metaphorically jumps up and down with glee, 
thinking it has managed to find the right loophole and won't have to get out 
a chequebook.
13) Unfortunately for the PCT, it's dealing with Melissa Ford, who has 
resolved that she *will not* pay for her next box of sets.
14) Melissa expects an answer from a director (rather than the 'Service 
Redesign Manager' who's been jerking her around for the past 5 months) by 
Wednesday morning, or she will get on a bus and go up to the PCT personally. 
She can be a witch on the phone, but that's nothing compared to the 
hysterics she can pull in person.

Don't make me angry (yes, I'm speaking in the first person again),

Type 1 10+ years; MiniMed pumper 7+ years; American 22+ years; bane of the 
Oxford City PCT's existence 2+ years
Co-ordinator, Oxford University Student Union Diabetes Network
Oxford area contact, INPUT

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