Commissioning through Evaluation

Background

NHS England’s Commissioning through Evaluation (CtE) programme enables a limited number of patients to access treatments that are not funded by the NHS, but nonetheless show significant promise for the future, while new clinical and patient experience data are collected within a formal evaluation programme.

There are two main phases to the programme:

  • Phase 1 – an agreed number of patients are recruited to a CtE scheme within just a few selected centres across England. The National Institute for Health and Care Excellence (NICE) helps to identify the total number of patients who need to be recruited to the scheme to support data analysis. It is important to note that schemes may end earlier than expected, if enough patients have been recruited to support this analysis. Equally, the number of patients to be recruited may be increased, if, for instance, a scheme fails to recruit enough patients in a particular group. The closure of each scheme depends on the point at which sufficient patients have been recruited to complete data analysis. Only then does a scheme enter the second phase.
  • Phase 2 – the analysis phase will vary in length, depending on the evaluation measures agreed by clinicians and patients at the start of each scheme. For example, it may be important to test whether the expected benefits of a treatment have been both achieved, and maintained, at 12 and 24 months; or there may be a need to evaluate whether a treatment, such as a novel cancer treatment, has halted the disease process, or improved overall survival, at three and six months.

NHS England receives advice from NICE on the need for, and the length of, follow-up measures, as well as the number of patients who would need to be assessed at the various points of follow-up in order for the analysis to be completed.

This approach ensures that each CtE scheme provides valuable new data, beyond that already available from clinical trials, or where there is no clinical trial data, to inform future commissioning policy decisions.

Whilst any patients already being treated as part of a CtE scheme will continue to receive appropriate follow-up care, no new patients will be funded by NHS England during the subsequent analysis phase.

During the analysis phase, NHS England’s published policy position for the treatment concerned will continue to apply which will mean that the procedure will not be routinely available within the NHS.

Once the CtE evaluation report is available, or if other significant clinical trial information becomes available more quickly, NHS England’s published policy for the treatment concerned will be reviewed and a decision will be made with regard to whether NHS England will or will not make the treatment available within the NHS.

CtE scheme updates

There are currently six active schemes within NHS England’s CtE programme. It should be noted that schemes will only cease once planned patient recruitment numbers have been reached, therefore it is not possible to provide a definite scheme stop date in relation to a number of the schemes.


Selective Dorsal Rhizotomy (SDR): This is a procedure that aims to increase mobility in children with cerebral palsy, by selectively cutting nerves in the spine, to improve spasticity (muscle stiffness).


A total number of 140 patients, across five specialist centres are planned to receive this treatment by the end of March 2016 as part of the first phase. Once allocations have been used, no new patients can be entered into the scheme, as the scheme will then move into its evaluation (2nd) phase. It is anticipated that final evaluation of this scheme will be available in the summer of 2017. An interim report is expected in March 2016.

Any patients who are not listed for SDR to be carried out as part of the CtE programme, before the end of March 2016, will not be able to access this procedure within the NHS as NHS England’s policy to not routinely commission SDR will continue to apply.

Families wishing to consider alternative treatment options, Individual Funding Requests (IFRs) (in clinically exceptional cases) or self-funding options, should contact their GP or consultant for further information and/or guidance.

The five centres taking part in the SDR CtE scheme are:

  • Alder Hey Children’s NHS Foundation Trust
  • Great Ormond Street Hospitals NHS Foundation Trust
  • Leeds Teaching Hospitals NHS Trust
  • Nottingham University Hospitals NHS Trust
  • University Hospitals Bristol NHS Foundation Trust

Each of the centres had to demonstrate that they had the necessary experience, skills and capacity to provide SDR, and that their surgeons were operating on at least 10 children a year.


Selective Internal Radiation Therapy (SIRT): This is a form of radiotherapy using radioactive beads to treat cancerous tumours in the liver.


A total of 10 centres are participating in the SIRT CtE scheme. They are:

  • Cambridge University Hospitals NHS Foundation Trust
  • Kings College Hospital NHS Foundation Trust
  • Leeds Teaching Hospitals NHS Trust
  • Newcastle upon Tyne Hospitals NHS Foundation Trust
  • Nottingham University Hospitals NHS Trust
  • Oxford University Hospital NHS Trust
  • The Christie NHS Foundation Trust
  • The Royal Free London NHS Foundation Trust
  • University Hospitals Birmingham NHS Foundation Trust
  • University Hospital Southampton NHS Foundation Trust

Percutaneous Mitral Valve Leaflet Repair (Mitraclip): This procedure is used to treat mitral regurgitation in patients with heart failure.


The three centres participating in this scheme are:

  • The University Hospital of South Manchester NHS Foundation Trust
  • University Hospitals Bristol NHS Foundation Trust
  • Royal Brompton and Harefield NHS Foundation Trust

Patent Foramen Ovale (PFO) Closure: This procedure is used to prevent recurrent stroke.


Specialist centres taking part in this scheme across England are:

  • Barts Health NHS Trust and The Heart Hospital, University College London Hospitals
  • Brighton & Sussex University Hospitals NHS Trust
  • Central Manchester Hospitals NHS Foundation Trust/University Hospitals of South Manchester NHS Foundation Trust
  • Guy’s and St Thomas’ NHS Foundation Trust
  • King’s College Hospital NHS Foundation Trust
  • Leeds Teaching Hospitals NHS Trust
  • Liverpool Heart & Chest Hospital NHS Foundation Trust
  • Nottingham University Hospitals NHS Trust
  • Oxford University Hospitals NHS Trust
  • Papworth Hospital, in partnership with Essex Cardiothoracic Centre
  • Royal Brompton & Harefield NHS Foundation Trust
  • Royal Wolverhampton NHS Trust
  • Sheffield Teaching Hospitals NHS Foundation Trust
  • St George’s Healthcare NHS Trust
  • The Newcastle upon Tyne Hospitals NHS Foundation Trust
  • University Hospital Birmingham NHS Foundation Trust
  • University Hospitals Bristol NHS Foundation Trust
  • University Hospitals Leicester NHS Trust
  • University Hospital Southampton NHS Foundation Trust

Left Atrial Appendage Occlusion (LAAO): This procedure is used in the prevention of stroke.


Centres participating in this scheme are:

  • Barts Health NHS Trust and The Heart Hospital, University College of London Hospital NHS Foundation Trust
  • Brighton & Sussex University Hospitals NHS Trust
  • Guy’s and St Thomas’ NHS Foundation Trust
  • Kings College Hospital NHS Foundation Trust
  • Leeds Teaching Hospitals NHS Trust
  • Liverpool Heart & Chest Hospital NHS Foundation Trust
  • Oxford University Hospitals NHS Trust
  • The Newcastle upon Tyne Hospital NHS Foundation Trust and South Tees Hospitals NHS Foundation Trust
  • University Hospitals Leicester NHS Trust
  • University Hospital of North Staffordshire NHS Trust

Stereotactic Ablative Radiotherapy (SABR): SABR is a more precise delivery of radiotherapy, applying high doses of radiation whilst causing less damage to surrounding healthy tissues.


Centres participating in this scheme are:

Oligometastic Disease

  • Barts Health NHS Trust
  • Guy’s and St Thomas’ NHS Foundation Trust
  • Leeds Teaching Hospitals NHS Trust
  • Mount Vernon Cancer Centre (North and East Hertfordshire Foundation Trust)
  • Newcastle upon Tyne Hospitals NHS Foundation Trust
  • Nottingham University Hospitals NHS Trust
  • Oxford University Hospital NHS Trust
  • Royal Surrey County Hospital NHS Foundation Trust
  • Sheffield Teaching Hospitals NHS Trust
  • South Tees Hospitals NHS Foundation Trust
  • The Christie NHS Foundation Trust
  • The Clatterbridge Cancer Centre NHS Foundation Trust
  • The Royal Marsden Foundation Trust
  • University College London Hospitals NHS Foundation Trust
  • University Hospitals Birmingham NHS Foundation Trust
  • University Hospitals Bristol Foundation Trust
  • University Hospitals of Leicester NHS Trust

Re-irradiation of pelvis and spine

  • Barts Health NHS Trust
  • Guy’s and St Thomas’ NHS Foundation Trust
  • Leeds Teaching Hospitals NHS Trust
  • Nottingham University Hospitals NHS Trust
  • Mount Vernon Cancer Centre (North and East Hertfordshire Foundation Trust)
  • Oxford University Hospital NHS Trust
  • The Royal Marsden NHS Foundation Trust
  • University Hospitals Birmingham NHS Foundation Trust

Hepatocellular carcinoma

  • Barts Health NHS Trust
  • Guy’s and St Thomas’ NHS Foundation Trust
  • Leeds Teaching Hospitals NHS Trust
  • Mount Vernon Cancer Centre (North and East Hertfordshire Foundation Trust)
  • Oxford University Hospital NHS Trust
  • The Royal Marsden NHS Foundation Trust
  • University Hospitals Birmingham NHS Foundation Trust

A number of new potential CtE schemes are under consideration by NHS England. Updates regarding existing, and any new, schemes will be provided here in due course.