Osseointegration - NHS perspective
As you are aware this is not currently routinely commissioned by the NHS (National Health Service). The NHS has sought legal advice as to the NHS Responsibility where patients have self-funded for this procedure. The advice given is that:
- As a DSF is not usually available on the NHS there is no obligation on the NHS to replace any component of the DSF.The NHS Policy ‘Defining the Boundaries between NHS and private healthcare’ states that "when a patient [pays] privately for additional treatment not usually funded by [NHSE], the patient will be required to pay all costs associated with the privately funded episode of care. The costs ...include complications of treatment where these are solely a consequence of the privately funded treatment, except where the patient is admitted under emergency care".
- Clinical responsibility for any issues involving the privately-funded implant and any privately funded prosthesis would lie with the private healthcare provider.
- When patient pays privately for additional treatment not usually funded by NHSE (National Health Service England), the patient is required to pay all costs associated with the privately funded episode of care. The costs of all medical interventions and care associated with the treatment include costs of assessments, inpatient and outpatient attendances, tests and rehabilitation. This also includes complications of treatment where these are solely a consequence of the privately funded treatment.
- If a patient commences a course of treatment that NHSE would not usually fund, NHSE will not pick up the costs of the patient either completing the course of treatment or receiving on-going treatment.
- If the prosthesis required for patients with a Direct Skeletal Fixation (DSF) is a prosthesis which is also available to NHS patients who do not have a Direct Skeletal Fixation implant, there may be an obligation on the NHS to provide the prosthesis (depending on factors including the procedures involved).
- If the prosthesis required for patients with a Direct Skeletal Fixation is not of a type available to patients on the NHS who do not have a Direct Skeletal Fixation implant, it is our view that the NHS does not have an obligation to provide this type of prosthesis. To do so would put the patient in a more advantageous position than those who cannot afford to fund the DSF implant privately which goes against one of the NHS's core principles.
- The ‘fail safe’ adaptor which attaches the prosthesis to the Direct Skeletal Fixation provided as part of the privately funded healthcare 'episode', is part of the Direct Skeletal Fixation rather than part of the prosthesis therefore not the responsibility of the NHS.
- If the Direct Skeletal Fixation is provided by private healthcare provider and the prosthesis is provided by the NHS, the two would have to be provided under separate interventions on the basis that "private and NHS funded care cannot be provided to a patient in a single episode of care at a NHS hospital". The DoH 'Guidance on NHS patients who wish to pay for additional private care states "there should be as clear a separation as possible between private and NHS care"
- If prosthesis is unique to the Direct Skeletal Fixation and not available on the NHS, it would have to be provided privately. Whether or not the provision of the prosthesis would constitute part of the Direct Skeletal Fixation treatment package would depend on the mechanisms involved in attaching the prosthesis.