Will the NHS fund my treatment?

Every year, NHS Kernow receives money from the Government to pay for health services. It is our responsibility to achieve best value for money and to spend it for the benefit of all our population. 

Demand for healthcare continues to grow and we have to prioritise the most effective and cost effective treatments available. Decisions to fund new treatments mean less is available for other health services. Difficult choices have to be made over the health care we can afford and which benefits the most people. We try hard to make these choices in a way which is impartial, consistent and fair.

Can I get treatment not normally funded by the NHS?

Your clinician can ask NHS Kernow to fund a treatment if they consider there to be an ‘exceptional clinical need’.

What does exceptional clinical need mean?

In making an application the clinician needs to provide evidence that the patient is significantly different to the general population of patients with the condition in question and is likely to gain significantly more benefit from the intervention than might be normally expected for patients with that condition.

How are decisions made?

Requests for funding are considered by the individual funding requests panel.

Ethical decision-making principles

We stress the need for decisions to be impartial and fair. All decisions are made after taking into account all of the following:

  • Evidence of clinical and cost effectiveness
  • The needs of the patient
  • The needs of the community
  • Exceptional clinical need

What can I do if funding is not approved?

  • Reconsideration: If there is new or additional evidence which the panel did not see, a case can be made for reconsideration
  • Appeal: If it is felt that the Panel did not follow the decision making process as outlined in the individual funding request policy (PDF, 521 KB). Any appeal must be made within four weeks of the panel decision
  • Complain: If you are unhappy with the outcome

Your personal confidential information

Where we do not have arrangements in place for a particular treatment or procedure to be provided, your GP or hospital clinician will need to make an application so that the panel can make a decision on whether funding should be approved.

When the panel discuss this application they need to have all the relevant information to make an informed decision. We need to know your name and contact details so that we can correspond with you if necessary. We also need other information about your health which is relevant. This may include medication, test results and photographs.

Your information is shared with the Individual Funding Requests team who arrange for it to be discussed by the panel. All staff working for the NHS have a duty to ensure that your information is kept safe and is only shared so that a funding decision can be made. Details of who is involved in seeing your personal information can be found in the individual funding request policy (PDF, 521 KB).

You have the right to access the record we hold. You also have the right to object to us making use of your information, restrict what information we use and to correct information if it is not accurate.