4. Mr U complains NHS Surrey Heartlands ICB should have accepted he had a clinical need, and so provided, a T:slim insulin pump from October 2022 to May 2024.
5. As a result of being denied the T:slim pump, Mr U says he has been unable to control his glucose levels sufficiently which has affected his education and caused unnecessary stress.
6. Mr U seeks policy change to prevent other children having the same issues.
7. Mr U is a teenager with type 1 diabetes.
8. His previous insulin pump worked by reacting to his blood glucose levels in order to bring them back up or down to where they should be. This meant he experienced highs and lows. He says this affected his education and his participation in sport.
9. The T:slim is a newer pump on the market which can predict when his glucose levels would fluctuate in order to keep his levels steady, to the avoid highs and lows he experienced with his old pump.
10. During a conversation with a clinician October 2022, Mr U and his father discussed whether he would benefit from the T:slim pump instead of the pump he had at the time.
11. The ICB declined a request for a T:slim pump. It explained the technology is always improving and Mr U would have to wait until the four-year warranty on his old pump had expired before getting a new pump.
12. Mrs U requested they pay the out the rest of the four-year warranty so Mr U could get the T:slim sooner. The ICB declined, explaining this is to ensure it is fair for everyone.
13. Mr U got the T:slim in May 2024, three months before the four-year warranty ended. He is very happy with the new pump.
18. The law gives us the direction to decide if we should carry out a detailed investigation of a complaint or not. 3.10 of our Service Model Guidance gives more information on the circumstances when we might decide not to investigate further. It states there will be occasions when we decide that there are other reasons why we should not investigate a complaint made to us. One of these reasons are if the outcome sought by the complainant is not achievable.
19. Mrs U and Mr U feels the ICB should have accepted he had a clinical need for the T:slim insulin pump before having to wait for the four year warranty to end. As a result of the complaint, they seek policy change to the way the ICB decides when people need new insulin pumps.
20. The ICB informed us via email that when the Trust and Mr U originally requested the new T:slim pump, the old pump was still functioning and still within the four year warranty. This is consistent with point 3.4 of NICE TAE guidelines which states state that tethered inulin pumps have a 4-year warranty.
21. The ICB response also told us the original insulin pump funding was agreed in August 2020 and so the funding was in place until August 2024.
22. It explained there was had been some confusion and the Trust had incorrectly advised Mrs U and Mr U that the funding was in place until May 2024, not August 2024. The Trust diabetes team requested the ICB honour the request for a new pump in May, and the ICB agreed. This why Mr U got his T:slim pump in May 2024, rather than when the warranty had ended in August.
23. The ICB response dated 15 January 2024 explained diabetes technology is ever evolving and therefore there will always be a better pump than pumps released potentially nearly four years ago. Moreover, it said that because insulin pumps cannot be reused by other patients, it would not be an effective use of NHS money to replace functional pumps before the four years are up. The ICB has not shown us the specific policy showing this, but we understand its position on how it provides pumps from the response and its reply to our enquiries.
24. We believe the ICB’s policy is not inconsistent with relevant any NICE guidelines, including NICE TAE guidelines mentioned above and NICE NG18 which state that the choice of insulin regime should be discussed with patients to ensure they are compatible. We have seen no guidance which suggests a functional insulin pump should be replaced before the four years are up, based on clinical or any other need.
25. It is often difficult for us to become involved in matters of policy. This is unless there is a clear indication a local policy, such as the ICB’s, is out of step with national guidance. We have to take into account the role the ICB has to set policy in its area and has a certain amount of discretion to decide on that.
26. We appreciate the ICB has strict budgetary requirements. We do not believe we would have grounds to recommend the ICB changes its policies in regard to how it funds medical technology, as is the sought outcome on this case. Therefore, we do not consider this sought outcome to be achievable and so we will not take any further action, as 3.10 of our SMG states.
27. We understand Mrs U and Mr U’s frustration and the struggles they encountered with the old insulin pump and so we understand they may be disappointed with our decision.
28. As they are seeking a policy change at the ICB, this might be a matter they wish to raise with their MP or the Department of Health. Those parties might be able to advise on raising for consideration on national policy level. This might be a more appropriate next step to change in the NHS provision for insulin pumps than our service is.
29. We were pleased to hear they are much happier with the new T:slim pump. We wish them well for the future.
1. We have carefully considered Mr U’s complaint about NHS Surrey Heartlands Integrated Care Board (the ICB). His complaint is about its decision to not provide him with a T:slim insulin pump.
2. We understand this caused a lot of frustration for Mr U and his family and affected his school life. We were sorry to hear about his difficult experience.
3. We have decided we would not be able to achieve the outcome Mr U and his mother, Mrs U, seek to resolve their complaint. Because of this, we have decided not to consider the complaint further. We explain our decision in this statement and hope it does not cause any further distress to them.