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Re: [IPk] Pump funding

Dear all,

This is exasperating, isn't it? I work in a Health Board Finance Department,
so I might be able to shed some light on things. Please forgive me if this
gets a bit technical.

First of all, by now people within all Boards and Trusts should have met
with Diabetes staff and identified the current situation (i.e. for those
currently on pumps, and those who went on pumps by the early summer).
Between them they should have made a decision as to the best way forward,
even if that is a temporary decision for now (e.g. funding for monthly
consumables, with further discussion to be held about funding for pump
purchase). Let me assure you of something here: the only time a Finance
Department holds things up is if a Diabetes Department recommends funding
but doesn't have money in their budget to meet that commitment. By statute,
a Board or Trust is not allowed to overspend, so a Finance Department
obviously has to ensure that spending is kept within budget. (Yes, I know
Boards and Trusts have overspent. But they have to get permission to do so,
and make good the loss within a fixed period, so services in future years do
suffer. And, normally, senior staff will have lost their jobs.)

The real problem is how NICE (in Scotland, the Health Technology Board, now
part of QIS) was set up. Although they can recommend that new drugs, etc be
used, the process doesn't include a pathway to the Treasury advising them
that additional funding will be required for the new treatments (which are
normally more expensive than existing ones). When NICE reported on pumps
Boards and Trusts had already received their funding allocations for
2003/2004, so they are having to fund a treatment they hadn't budgeted for.

The situation gets even more interesting when you realise there is a
difference between England and Scotland. In England it "is expected" that
Boards and Trusts will meet NICE guidelines. In Scotland it "is anticipated"
that NICE/QIS guidelines will be met. That's quite a difference. It's so
much of a difference that it has resulted in several Scottish Boards and
Trusts taking legal advice and finding out it is in order for them to review
QIS guidelines and decide whether or not the recommendations should be
applied within that Trust or Board (and, if so, how widely).

Please don't think I am making excuses for Boards and Trusts here.
Personally I believe that all those meeting the guidelines (and those who
have particular needs) should be able to get a fully-funded pump. If
Boards/Trusts are finding they don't have the funding for this or any other
treatment, they should present their case to the Department of Health (if
they joined together and presented a united front it wouldn't be long before
funding would miraculously appear!).

I hope this explains the situation a little. Be assured of one thing... it's
not just some people in Diabetes Departments who blame a funding issue or
delay on Finance!!


----- Original Message ----- 
From: <email @ redacted>
To: <email @ redacted>
Sent: Tuesday, September 30, 2003 3:52 PM
Subject: Re: [IPk] Pump funding

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> Hi Jane
> We seem to be in the same boat as you, our son Ryan has had the go ahead
> a pump sine June, he fits in with the NICE guidelines, his consultant has
> yes...even the PCT (Warrington) have said they will not refuse our
>  application but we seem to have come to a standstill. When I ask the DSN
> says they
> are waiting to meet the pump companies to make a decision as to which
> we should go to but....The meeting is supposed to be tomorrow but I've not
>  heard anything & our DSN has been on hols. We're at clinic 8th Oct so I'm
> to
> try and pin them down then.
> By the way we were told our PCT needed a letter from the consultant (& no
> else) recommending a pump but I don't know any further than that.
> I was hoping Ryan would have his pump by christmas (and still am)
> Maybe someone who has been through the process can shed some light on the
> holdups?
> Denise mum to Ryan age 7 dxd @ 9 months old 6 units Lantus + NR
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