The Review of Clinical Policies for Lancashire and South Cumbria Clinical Commissioning Groups (CCGs) – Frequently Asked Questions (FAQs)

Sensory integration therapy is a direct, one-to-one clinic-based therapy for children and adults who have been assessed to have a level of sensory interference or dysfunction. In reality, this treatment, where undertaken at all, tends to focus on children more than adults. Some consideration was being given to including sensory integration therapy in children’s Education, Health and Care plans but before this could be done it was important to determine how effective this therapy was in supporting sensory integration.

As there is now a greater awareness of the impact of sensory integration therapy, the CCGs across Lancashire and South Cumbria felt they needed to develop a commissioning policy for this treatment. This would assess the latest clinical evidence and determine whether there were grounds to fund this treatment and, if so, the clinical circumstances that should be met for any funding to take place. A commissioning policy would also determine whether there were not enough grounds to support funding.

Sensory integration therapy is a direct, one-to-one clinic-based therapy for children and adults who have been assessed to have a level of sensory interference or dysfunction. The therapy is usually delivered by an Occupational Therapist (OT) with the intention of reducing the impact of the person’s sensory dysfunction/disorder.  However, there is no common approach or agreement on how to define sensory integration and in practice, sensory integration therapy tends to be offered to children who have ADHD or ASD, but this is by no means a common practice.

People understand and respond to their environment through interpreting the messages they receive from their senses (sight, hearing, touch, taste and smell). Both adults and children can have problems that interfere with the processing of information from the senses and how this comes together to give order to their surroundings.

This interference with the senses can be interpreted as a disorder or dysfunction of the senses. Sensory integration dysfunction or sensory processing disorder is a condition in which the brain has trouble receiving and responding to information that comes in through the senses. However, there is no clearly defined interpretation or recognition of this problem as a medical condition.

Some people who struggle to make order of their senses are oversensitive to things in their environment, to light, sound, things they can touch or a combination of things that overwhelm their senses. Others may be un-coordinated, be unable to tell where their limbs are in space or be hard to engage in conversation or play.

Sensory integration or processing problems are usually identified in children and are commonly seen in developmental conditions like autism spectrum disorder, but they can also affect adults.  The policy, therefore, is aimed at all age groups. 

This policy relates to requests for one-to-one clinic-based sensory integration therapy from or for patients (adults or children), including the provision of associated equipment. However, there is not enough evidence to support the use of sensory integration therapy as an effective and cost-effective means of reducing the impact of a person’s sensory dysfunction.

Until more evidence is available the CCGs in Lancashire and South Cumbria do not feel they can commit their limited resources to the funding of this process. The new policy, therefore, reflects this position and indicates that the use of sensory integrated therapy for the management or reduction of sensory dysfunction will not be routinely funded.

As sensory integration therapy is not considered to be an effective treatment, patients would benefit more from receiving alternative treatments. In addition, this would mean better use is made of limited NHS resources for the greater benefit of patients generally.

This does not mean that the assessment of sensory needs will not be included in the existing assessment of children with ASD/neurodevelopmental issues, as this remains a valuable approach. In addition, advice and guidance to parents and teachers on the management of the child should include consideration of sensory needs and how they may be supported in daily life. The policy does not prevent these from taking place but does not support integrated therapy as a treatment.

The policy indicates that this treatment will not be routinely funded. If your GP or consultant is of the opinion that your case in an exception then, as with other clinical policies, your clinician can put in an Individual Funding Request, which are decided on a case-by-case basis.

Every NHS Clinical Commissioning Group (CCG) is responsible for determining the range and level of clinical/medical services provided to the public it serves. In doing so CCGs are legally obliged to develop and publish any policies it has adopted to determine the availability of specific treatments or procedures for the local population.

A clinical commissioning policy is a document that describes in an open and transparent manner in what circumstances a CCG or group of CCGs will commission (give authority to undertake, pay for and monitor) specific healthcare services, treatments or procedures.

Clinical commissioning policies are evidence-based but must also reflect other important considerations such as cost and affordability. They are subject to regular reviews, usually every three years, but this may be more frequent depending upon the treatment/procedure concerned, the impact of clinical research and development and the pressures upon the health economy.

A CCG must make sure it is using its limited resources to maximum benefit for each patient treated and for the population it serves. It must also ensure it is commissioning the most effective and appropriate healthcare treatments and procedures. This means making decisions about priorities and about which treatments and procedures will and will not be provided under the NHS in their area.

Clinical policies are intended to provide a resource that can be used to ensure a consistent understanding of the specific clinical circumstances that must be met for a treatment or procedure to be commissioned by a CCG. Policies can be used for this purpose by stakeholders across the system including clinicians, commissioners, appeals panels and patients.

The main objective for having a commissioning policy is to ensure that:
• Patients receive appropriate, evidence-based health treatments in the right place, at the right time.
• Treatments that are routinely undertaken represent the most effective and cost- effective use of the limited resource available.
• Treatments with no or a very limited clinical evidence base are not routinely undertaken.
• Treatments with minimal health gain are restricted.
• The risk of avoidable harm is reduced. With all surgical treatments and procedures, there is always a risk of complications and adverse effects which could be avoided.
• Clinicians are assisted in maintaining their professional practice in line with the changing evidence base.
• Available resources are maximized, and waste is avoided as ineffective care is poor value for money for the taxpayer and the NHS.

Clinical policies are developed and ratified within and form part of a robust governance framework. In developing this framework CCGs have had regard to relevant law and guidance, including their duties under the National Health Service Act 2006, the Health and Social Care Act 2012 and the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012; the Joint Strategic Needs Assessment; and relevant guidance issued by NHS England.

CCGs must also have due regard to the guidance issued by NICE (National Institute of Health and Care Excellence), some of which is statutory. Even where NICE guidance is not statutory, CCGs must be able to justify deviations from the guidance provided.

All clinical commissioning policies are built upon and supported by a statement of principles. The principles are appropriateness; effectiveness; cost-effectiveness; ethics and affordability, which all clinical policies must meet. Together with a policy regarding clinical exceptionality and the general policy for decision-making, these documents form a suite of policies that create a governance framework for the formulation and ratification of clinical policies.

The governance framework is supported by all eight CCGs in Lancashire and South Cumbria and provides a consistent, equitable and sustainable system for decision-making that meets the demands placed upon CCGs by statute and the NHS Constitution.