Richard Crookes Resource Centre Manager NHS Nottingham City IFH Study Day, York Hospital

1. Individual Funding Requests (IFR) & Joint Strategic Needs Assessments (JSNA) Richard Crookes Resource Centre Manager NHS Nottingham City IFH Study Day, York Hospital 4th February 2010

2. Objectives Individual Funding Requests • Background to IFRs • The IFR panel • The role of the librarian Joint Strategic Needs Assessment • What is the JSNA? • National & local picture • The role of the librarian

3. DH Expectations of the PCTs • The NHS allocates finite resources on the basis of clinical need • No duty of care owed by PCTs to patients • Increase the healthy lifespan of your client population • Reduce inequality in healthy lifespan of your client population • Break even! • A fixed budget to fund comprehensive health care • A statutory duty not to exceed budget • Cannot afford every healthcare intervention

4. Why Have IFR Panels? • PCTs need to make decisions in relation to treatment requests not currently commissioned by the PCT • IFRs – • Interventions for which there is no specific commissioning policy • Interventions for which a specific policy ‘not to routinely fund’ is in place • Where the patient doesn’t fulfill the criteria

5. Exceptionality • A rare or unusual event • Far beyond what is usual in magnitude or degree • Exceptional likelihood of benefit • Most cases that come before Panel are not in any way, shape or form exceptional

6. NHS E Midlands IFR Policy • Background • Richard’s Report identified ‘unexplained variations’ in individual funding decisions between PCTs • EMSCG developed regional IFR policy (2009) • Purpose • To reduce potential ‘postcode funding’ • Develop clarity around the ethical principles underpinning IFR decisions • To support greater consistency in the process and decision-making between PCTs in E Midlands • Quality assurance of the process across the 9 PCTs

7. The IFR Panel • Pre-screening • Multidisciplinary panel: chair, medical director, consultants, commissioning manager, senior pharmacist & librarian • Voting members • Monthly meetings • Main responsibility answering complex (clinical) enquiries • Decisions

8. Evidence Gathering • Searcher must have full case documentation (PICO) • Evidence sources: • NICE, SMC, HTAs, CE, CKS • TRIP, Cochrane, MEDLINE, EMBASE • Google Scholar • NeLM, DTB, MeReC, conferences • Levels of evidence: 1 & 2 • Presentation of results

9. Examples of Requests Umbilical Blood Cord Transplantation (UBCT) for severe Aplastic Anaemia in adults Magnetic Navigation System Cardiac Ablation for Ventricular Tachycardia (VT) Imatinib (Glivec™) for Gastrointestinal Stromal Tumour (GIST) - exon 11 mutation • MRgFUS for uterine fibroids (pedunculated) • Ganciclovir Implants for cytomegalovirus (CMV) retinitis • ACI & Meniscal graft • IVF low weight (mother) • Irinotecan for Ewing’s Sarcoma • Sorafenib for Advanced Hepatocellular Carcinoma

10. Issues & Challenges • Short notice • Timescales • Search requests • Quality of evidence • Appraisals (what to exclude) • Writing summaries • Staff cover for panels

11. Coming to a PCT near you! • Regional collaboration • IFR librarians • Standardisation of IFR search results • GRADE methodology • EMSCG repository of searches • MK • NHS Nottingham City

12. Joint Strategic Needs Assessment (JSNA) Richard Crookes Resource Centre Manager

13. What is a JSNA? • A “means by which PCTs and Local Authorities will describe the future of health and well-being needs of local populations and the strategic direction of service delivery to meet these needs” – Department of Health (2007) Commissioning for Health and Wellbeing • Requirement for PCTs and local authorities to produce a Joint Strategic Needs Assessment of the health and wellbeing of their local community (The Local Government and Public Involvement in Health Act 2007) • Identifies the current and future health and wellbeing needs of a population

14. Joint Strategic Needs Assessment (JSNA) I • Undertaken by Directors of Public Health, Adult Social Services and Children's Services working in collaboration with Directors of Commissioning • Provides analysis of data to show the health and wellbeing status of local communities, defining where inequalities exist and using local knowledge alongside evidence of effectiveness of interventions

15. Joint Strategic Needs Assessment (JSNA) II The JSNA process should: • Lead to agreed commissioning priorities that will improve health and wellbeing outcomes and reduce health inequalities. • Reflect the competencies of a World Class Commissioner, being underpinned by: • partnership working; community engagement; • evidence of effectiveness: identifying relevant best practice, innovation and research to inform how needs will best be met. • Be continuous • What we PCTs should be doing based on the evidence

16. JSNA in Nottingham I • Driven by a steering group with representatives from NHS Nottingham City, Children’s Services and Adult Support and Health and facilitated by jointly-funded project manager • Designed to be used by Nottingham’s health and social care commissioners to ensure plans and available resources meet Nottingham’s health and wellbeing needs • The JSNA is updated regularly • 1st round 2008 • JSNA development workshop in October 2009 • The 3rd round of JSNA will be published in April 2010.

17. JSNA in Nottingham II • Standard Template • Consists of 42 chapters e.g. Alcohol, End of Life, Mental Health, Asylum Seekers, refreshed annually • Wide authorship • Wide readership • Approaching its 3rd round • Available on the Nottingham Insight website (Feb 2010) • Knowledge Resources support re advising on consistent referencing e.g. Harvard style

18. JSNA on Nottingham Insight

19. JSNA Chapters’ Template

20. Librarian Involvement • Identifying high-quality evidence • Updating referenced materials • Using non-medical resources e.g. SCIE, Campbell Collaboration • Organising website content • Referencing of cited documents • Storage of key documents, works cited

21. Thank You! Richard Crookes Resource Centre Manager Knowledge Resources Tel 0115-883 4213 email: richard.crookes@nottinghamcity.nhs.uk