4. Ms H complains she has not been able to access electrolysis hair removal treatment since 14 February 2020 because the ICB did not provide a list of suitable providers.
5. Ms H also complains the ICB is unwilling to provide funding so she can access hair removal therapy at her preferred private clinic.
6. Ms H says the lack of treatment and suitable support has led to inconvenience, frustration and distress.
7. Ms H wants a financial payment to fund private treatment.
8. Ms H has polycystic ovary syndrome (a condition affecting how a woman’s ovaries work) and due to this she has thick hair on her face and chest.
9. On 10 February 2020, Ms H’s GP made an IFR for electrolysis hair removal therapy.
10. On 25 February, the ICB advised the GP that funding for hair removal was allowed under the existing commissioning policy and an IFR was not needed in these circumstances. It said the GP could do a referral to a relevant service that had a contract with the NHS.
11. In June 2021, Ms H asked if she could have the treatment at a specific clinic that did not have an NHS contract for hair removal electrolysis. The chosen clinic did not have CQC (Care Quality Commission) registration.
12. The ICB advised it would not be able to fund treatment at a non-CQC clinic as it would not be assured of the quality and safety of care.
13. In September, after ‘extensive research’, Ms H found a CQC registered clinic and had her first appointment.
14. Sadly, after the appointment she was concerned about the clinic’s hygiene and did not go ahead with treatment.
15. On 23 September, Ms H’s GP made an IFR application specifically for Ms H’s preferred clinic.
16. An IFR application can be made by the clinician treating you, if they think that your clinical circumstances are exceptional and you may benefit from a treatment or service that is not routinely offered by the NHS.
17. An IFR was necessary because Ms H’s preferred clinic did not have an NHS contract for hair removal electrolysis and was not CQC registered.
18. On 15 December, the ICB told Ms H’s GP the application had been declined.
List of providers
21. Before we decide if we should do a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not seen any signs that something has gone wrong.
22. Ms H complains that she has not been able to access electrolysis hair removal treatment from 14 February 2020 because the ICB did not provide a list of suitable providers.
23. She explains that she would be able to access treatment if the ICB could tell her the providers that are suitable.
24. Ms H says the responsibility is put on her to find suitable clinics. She explains that the GP cannot make a referral to the local NHS dermatology teams, because these do not offer electrolysis hair removal treatment.
25. She also explains it is not easy for her to find suitable clinics that would meet the criteria set by the ICB (having an NHS contract and CQC registration).
26. The Responsibilities and Standing Rules Regulations 2012 say the responsibility of the ICB is to have written procedures and policies in place for considering IFRs, to provide written decisions and to provide funding if all the requirements have been met.
27. The ICB’s IFR policy explains the ICB has a statutory responsibility to commission care within available resources.
28. We recognise that Ms H would find it useful to have a list of the clinics that provide electrolysis hair removal treatment.
29. We are pleased to see the ICB’s IFR policy is in line with the Responsibilities and Standing Rules Regulations 2012. It is clear from Ms H’s ‘extensive research’ that it has commissioned care within available resources. It is also clear that, based on the ICB’s IFR policy, the ICB had written documentation available as per the regulations.
30. Based on the above regulations and the ICB’s IFR policy, we can see the ICB is not responsible for providing a list of the clinics where electrolysis hair removal therapy might be provided.
31. We are reassured to see Ms H found a clinic that was suitable in September 2021. Sadly, she was unhappy with the first appointment at the clinic and did not complete the treatment course.
32. We are satisfied that Ms H understands the process and we accept it could be easier for her to find suitable treatment providers if all the relevant providers were on a list.
33. We have decided that, although it is difficult, the responsibility for finding suitable clinics that would meet the ICB’s criteria rests with Ms H. This means we do not think the ICB did anything wrong by not giving her a list of clinics.
Preferred clinic
34. Ms H explains that she found a clinic where she would he happy to have electrolysis hair removal treatment, but the ICB declined the funding because it was not CQC registered.
35. The ICB said the reasons the IFR was declined was because CQC registration gives reassurance that it is funding a service that is appropriately monitored for quality and safety. The ICB explains that, under the NHS Constitution, all patients have the right to expect appropriately monitored services.
36. The NHS Constitution establishes the principles and values of the NHS in England. It sets out rights to which patients, public and staff are entitled and pledges what the NHS is committed to achieve. It states the responsibilities of the public, patients and staff to make sure the NHS operates fairly and effectively.
37. It says: ‘You have the right to be treated with a professional standard of care, by appropriately qualified and experienced staff, in a properly approved or registered organisation that meets required levels of safety and quality.
You have the right to expect NHS bodies to monitor, and make efforts to improve continuously, the quality of healthcare they commission or provide. This includes improvements to the safety, effectiveness and experience of services.
You have the right to drugs and treatments that have been recommended by NICE [National Institute for Health and Care Excellence] for use in the NHS, if your doctor says they are clinically appropriate for you.
You have the right to expect local decisions on funding of other drugs and treatments to be made rationally following a proper consideration of the evidence. If the local NHS decides not to fund a drug or treatment you and your doctor feel would be right for you, they will explain that decision to you.’
38. The ICB’s IFR policy says as a minimum the ICB should consider national guidance and patient safety when making a decision on an IFR.
39. We reviewed the IFR application and can see it includes information from Ms H. More importantly, we can see that the ICB considered the information Ms H got from the CQC. The ICB reviewed the CQC’s ‘Scope of registration’ and decided the exemption the CQC referred to was in respect of medical practitioners in independent practice not being required to register separately.
40. The CQC is an independent regulator of healthcare in England. It aims to make sure health and social care services give people safe, effective, compassionate, high-quality care and it encourages care services to improve. It does this through registration of an organisation, monitoring, inspections and issuing fines or prosecuting cases where people are harmed or put in danger of harm.
41. We have seen evidence, in the Responsibilities and Standing Rules Regulations 2012, that the ICB has responsibility to consider and provide funding for treatments.
42. As the ICB commissions NHS funding (money from NHS England) it must comply with the NHS Constitution.
43. We are pleased to see that the ICB’s IFR policy refers to the NHS Constitution and takes NHS values into consideration.
44. We can see that under the NHS Constitution Ms H has the right to be treated with a professional standard of care, by appropriately qualified and experienced staff, in a properly approved or registered organisation that meets required levels of safety and quality.
45. We are pleased that the ICB considered safety in line with its own policy when reviewing Ms H’s IFR request at the preferred clinic.
46. We are also satisfied that the ICB provided the reasoning for the decision and referred to relevant national guidance (the NHS Constitution).
47. We also consider that the decision to consider CQC registration for ‘appropriate monitoring of safety and quality’ is reasonable because the ICB does not have responsibility to directly check and monitor safety and quality of services, but this is the duty of the CQC.
48. The ICB does fund electrolysis hair removal treatment by a GP referral to an NHS-funded clinic or dermatology team. We know this system works because Ms H attended a CQC registered clinic with an NHS contract for her first session.
49. We recognise that Ms H was not happy with this clinic and was able to raise her concerns directly with the CQC.
50. Overall, the ICB acted in line with its policy when considering safety and quality of service. It gave clear reasons for its decisions and we do not think it did anything wrong.
We hope we have shown Ms H how carefully we looked at her complaint and we thank her for taking the time to come to us.
1. We have carefully considered Ms H’s complaint about NHS West Yorkshire Integrated Care Board (the ICB).
2. We are sorry to hear about the delay Ms H is experiencing in getting much-needed hair removal therapy. We can see this has caused distress and anxiety.
3. We have found the ICB acted in line with its Individual Funding Request (IFR) policy and with NHS England’s requirements. We have not seen any sign that anything when wrong.