Agenda item

Difficult Decisions Update

Report of the Clinical Commissioning Groups (CCG)


The Accountable Officer 6 Staffordshire and Stoke on Trent CCGs, Clinical Lead and Manager Difficult Decisions outlined the report which highlighted  initial engagement carried out early in 2020 and detail of the proposed engagement process regarding five areas of care: assisted conception, hearing aids for non-complex hearing loss (Mild hearing loss only), male and female sterilisation, breast augmentation and reconstruction and removal of excess skin following significant weight loss.


Concerns were raised relating to lack of hearing aid provision for people with mild hearing loss in North Staffordshire, the cost to people who may not be able to afford hearing aids and the potential impact on their mental wellbeing.  Committee noted the following comments and responses to questions:

  The decision to restrict provision hearing aids for people with mild hearing loss in North Staffordshire CCG was based on guidance, criteria and scorecard evidence provided against local priorities. The way the scorecard was applied by Clinical Priorities Advisory Groups CPAG may result in a different decision in different areas, depending on how the CPAG was made up and local circumstances. 

  North Staffordshire CCG was the only CCG in the County at this time to have looked at evidence relating to funding hearing aid provision and taken the difficult decision to restrict supply of hearing aids for mild hearing loss. Residents with moderate hearing loss were currently able to access hearing aids across all 6 Staffordshire and Stoke on Trent CCGs.

  All 6 CCGs would consider feedback, evidence, evaluate and prioritise as part of the difficult decision’s process and outcomes of the process could not be pre-determined. 


Members considered the process and involvement activities, work completed to date and proposed timelines and noted the following comments and responses to questions:

  The engagement process would feed into shaping the consultation process for all five of the difficult decisions.  The consultation process would be completed in March 2022 and would inform business proposals.

  All proposals would be considered through evidence of what was effective and beneficial to ensure services were what people need and that they were not discriminated against, advantageously or disadvantageously. Essentially people who currently accessed any of the five areas of care being consulted on may no longer be able to do so, or conversely people who did not have access may be able to access them as a result of this process.

  In April 2022, subject to legislation, the Integrated Care System would start to commission provision of care, some CCG decisions would be made before that happened. The Integrated Care Board would continue to commission and provide care equitably across Staffordshire.

  The clinical evidence considered by CPAG would be used to inform the proposals to be presented to this Committee.

  Other interested stakeholders to be consulted would include local groups involved in the specific areas of care.


The Chairman highlighted the need to ensure consistency across Staffordshire for residents, the need for service user engagement and to use all feedback from engagement, including evidence gathered earlier in the process, to develop proposals.



1.  That the report and process was noted.

2.  That the final proposals will be considered by the Committee at a future meeting.

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