Scope

This Clinical Reference Group (CRG) covers specialised ear surgery and specialised ophthalmology services.

Membership

Chair: Mr James Tysome, Consultant ENT Surgeon at Cambridge University Hospitals
Prof Bertil Damato, Clinical Member
Ms Sujara De, Clinical Member
Prof Stephen Kaye, Clinical Member
Prof Christopher Raine, Clinical Member
Ms Saaeha Rauz, Clinical Member
Mr James Ramsden, Clinical Member
Andrew Marshall, Affiliate Member
Simon Lloyd, Affiliate Member
Alison Davis, Affiliate Member
Melanie Hingorani, Affiliate Member
Nicola Symes, Lead Commissioner
Robert Wilson, Public Health England lead
Paddy Toner, Patient and Public Voice representative
Geoffrey Eggleston, Patient and Public Voice representative

Products

A key part of the CRG’s work is the delivery of the ‘products’ of commissioning. These are the tools used by the 10 Hub Commissioning Teams to contract services on an annual basis.

Service Specifications

Service specifications are important in clearly defining the standards of care expected from organisations funded by NHS England to provide specialised care. The specifications have been developed by specialised clinicians, commissioners, expert patients and public health representatives to describe both core and developmental service standards. Core standards are those that all funded providers should be able to demonstrate, with developmental standards being those which may require further changes in practice over time to provide excellence in the field.

The following service specifications fall within the scope of this CRG:

• Auditory Brainstem Implant
• Specialised Ear Surgery: Cochlear Implants (All Ages)
• Implantable Hearing Aids for Microtia, Bone Anchored Hearing Aids and Middle Ear Implants (All Ages)
• Specialised Ophthalmology (Adult)
• Specialised Ophthalmology (Paediatrics)
• Ocular oncology service (Adults and Adolescents)
• Ophthalmic pathology service (All Ages)
• Osteo-odonto-keratoprosthesis service for corneal blindness (Adult)
• National Artificial Eye Service (All Ages)

Policies

A commissioning policy is a document that defines access to a service for a particular group of patients. A NICE Technology Appraisal Guideline on the same topic will replace, or be incorporated into, a commissioning policy as appropriate. These are important documents that are developed to ensure consistency in access to treatments nationwide.

The following policies fall within the scope of this CRG:

Commissioned:

• Keratoprosthesis for corneal blindness (all ages)
• Auditory brainstem implant with congential abnomalities of the auditory nerves of cochleae
• Bone Anchored Hearing Aids
• Adalimumab Patient Information Leaflet
• Bone conducting hearing implants (BCHIs) for hearing loss (all ages)
• Rituximab for immunobullous disease

Not routinely commissioned:

• Argus II retinal prosthesis
• Infliximab (Remicade) as Anti-TNF Alpha Treatment Option for Paediatric Patients with Severe Refractory Uveitis
• Mercaptamine hydrochloride viscous eyedrops for corneal cystine deposits in people aged older than 2 years

Policy statements

Policy statements are brief documents that define the current commissioning position to support service contracting. They are interim documents for use while a full commissioning policy is being developed or until a formal NICE Technology Appraisal Guideline has been published.

The following policy statements fall within the scope of this CRG:

• Active Middle Ear Implants
• Idebenone for treating people over 12 years of age with Leber’s Hereditary Optic Neuropathy
• Serum eye drops for the treatment of severe ocular surface disease (all ages)