Lancashire Clinical Commissioning Groups (CCGs)

Policies for the Commissioning of Healthcare

Policy for the Commissioning of Cosmetic Procedures

(Provision of Wigs Only)

 

1            Introduction             

1.1         This document is part of a suite of policies that the CCG uses to drive its commissioning of healthcare. Each policy in that suite is a separate public document in its own right but will be applied with reference to other policies in that suite.      

1.2         This policy is based on the CCGs Statement of Principles for Commissioning of Healthcare (version in force on the date on which this policy is adopted).

             

2            Policy             

2.1       The CCG will not routinely commission any treatments or procedures that have the primary purpose of changing the appearance of a part of the body. 

The following procedures have been categorised as either ‘not routinely funded’ or ‘restricted’.  An explanation of these definitions are as follows:

Not routinely funded: These treatments are considered to be cosmetic and will only be provided if funding is approved on an exceptional case basis following the submission of an Individual Funding Request (IFR).

Restricted: The CCG will fund these treatments/procedures to treat the conditions set out below, provided the patient meets the intervention specific policy criteria at sections 2.1.1-2.1.24. In all other circumstances these interventions are considered to be cosmetic.              

2.1.15  Provision of wigs: Restricted

The CCG will commission wigs and prostheses for the correction of hair loss in the following circumstances:    

a.     where hair loss is a symptom of a health condition  

b.     as a consequence of chemotherapy   

c.      where hair loss is a result of physical trauma such as burns  

Provision does not extend to hair loss which occurs as a natural part of ageing for both males and females.  

Funding will normally be provided for one device per patient and replacements will be offered not more frequently than once every three years and then will be subject to assessment of continuing need. 

             

3            Scope and definitions           

3.1         Healthcare included within the scope of this policy is that having a primary purpose of changing the appearance of part of the body.  It may be suggested that such healthcare includes surgical operations, laser therapies, electrical stimulation, physiotherapy, massage, provision of wigs and prostheses, and other types of intervention.             

3.2         The scope of this policy does not include requests for medicines and medical devices which are available on NHS prescription. The Lancashire Medicines Management Group (LMMG) is responsible for making recommendations regarding the provision of such treatment. Their guidance can be viewed on the LMMG website, which can be accessed via the following link  http://www.lancsmmg.nhs.uk/          

3.3       Requests to address the following issues, irrespective of gender or age, are within the scope of this policy:

• Small breasts;
• Concerns about the shape of the breasts, including symmetry, sagging, and (when malignancy is not suspected) nipple inversion;
• Scar tissue;
• Prominent ears;
• Concerns about the size or shape of the, nose, chin or larynx;
• Concerns about the size or shape of the genital organs;
• Drooping or other issues relating to the eyelids;
• Skin flaps;
• Excess fatty tissue;
• Separation of the abdominal muscles (Diastasis Recti);
• Tattoo;
• Excess hair;
• Insufficient hair / hair loss;
• Split ear lobes;
• Pectus excavatum;
• Problems addressed by face lifts or brow lifts;
• Procedures to align appearance more closely to that of a particular gender;
• Revision of scars or keloid scars.
• Other conditions that the CCG considers to be equivalent to the above.            

3.4       The following are not within the scope of this policy:

• Procedures to manage cleft lip and / or cleft palate;
• Procedures on the genital organs as part of a package of gender reassignment;
• A procedure having the primary purpose of repairing a hernia to treat or prevent pain, discomfort, strangulation or incarceration, even if that procedure uses an abdominoplasty approach;
• Hair depilation as part of the management of a symptomatic or potentially symptomatic pilonidal sinus;
• Treatments for hyperhidrosis;
• Treatments undertaken as part of an ongoing package of cancer treatment;
• Cosmetic procedures for people undergoing gender reassignment if those procedures fall within the commissioning remit of NHS England.
• Reconstructive surgery following trauma or cancer.
• The treatment of genital warts.                         

3.5       The CCG recognises that a patient may have a concern about their appearance, which may or may not be caused by or amount to a medical condition and they may wish to have a service provided to improve their appearance. The CCG also recognises that they may be distressed by their appearance and by the fact that they may not meet the criteria specified in this commissioning policy.

Such features place the patient within the group to whom this policy applies and do not make them exceptions to it.                                                                

3.6       For the purpose of this policy the CCG defines:

• “Cosmetic" as relating to appearance.
• "Pathology" (adjective "pathological") is defined as a biologically based health problem which, in a cosmetic context, is likely to be caused by a congenital (including genetic) anomaly, infection or inflammation, trauma, neoplasia, or premature degeneration.            

3.7         The CCG will not commission cosmetic procedures simply on the basis of the mental health or psychological impact experienced by patients as a result of the appearance of their condition or the lack of funding. (Sec 3.4 of the Pan Lancashire Policy for Considering Applications for Exceptionality to Commissioning Policies.)           

3.8         The CCG is committed to eliminating discrimination and promoting equality in its own policies, practices, and procedures. While no protected characteristic under the Equality Act is automatically a matter for exceptionality under this policy, the CCG is committed to treating everyone equally and with the same attention, courtesy and respect regardless of their age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation.

             

4            Appropriate Healthcare             

4.1         The purpose of cosmetic surgery is normally to change the appearance.           

4.2         Some requests for cosmetic procedures arise from an appearance which is not pathological.  Such procedures do not have the intended outcome of preventing, diagnosing or treating a medical condition (paragraph 3.3a of the Statement of Principles).  Therefore, such requests do not accord with the Principle of Appropriateness.           

4.3       Some requests for cosmetic procedures arise from an appearance which, although related to pathology, is causing no significant symptoms apart from the appearance and the distress resulting from that appearance. A substantial number of people in the population will have these features.

The CCG considers other services competing for the same CCG resource more clearly have a purpose of preserving life or of preventing grave health consequences (paragraph 3.4(f) of the Statement of Principles).  The CCG also considers that the use of healthcare for the problem in question would amount to excessive medicalisation (paragraph 3.4(g) of the Statement of Principles).

Therefore, such requests do not accord with the Principle of Appropriateness.        

             

5            Effective Healthcare            

5.1       The CCG does not call into question the effectiveness of cosmetic procedures and therefore this policy does not rely on the Principle of Effectiveness. 

Nevertheless, if a patient is considered exceptional in relation to the principles on which the policy does rely, the CCG may consider whether the purpose of the treatment is likely to be achieved in this patient without undue adverse effects before confirming a decision to provide funding.

             

6            Cost Effectiveness             

6.1         The CCG does not call into question the cost-effectiveness of cosmetic procedures and therefore this policy does not rely on the Principle of Cost-Effectiveness.  Nevertheless, if a patient is considered exceptional in relation to the principles on which the policy does rely, the CCG may consider whether the treatment is likely to be Cost Effective in this patient before confirming a decision to provide funding.

             

7            Ethics         

7.1         The CCG does not call into question the ethics of cosmetic procedures and therefore this policy does not rely on the Principle of Ethics.   Nevertheless, if a patient is considered exceptional in relation to the principles on which the policy does rely, the CCG may consider whether the treatment is likely to raise ethical concerns in this patient before confirming a decision to provide funding.

             

8            Affordability            

8.1         The CCG has a limited budget and must make difficult choices.  As a result of the need to manage resources within budget, the Principle of Affordability is a basis for making restrictions to the commissioning of cosmetic healthcare. 

             

9            Exceptions             

9.1         The CCG will consider exceptions to this policy in accordance with the Policy for Considering Applications for Exceptionality to Commissioning Policies.             

9.2         In the event of inconsistency, this policy will take precedence over any non-mandatory NICE guidance in driving decisions of this CCG.  A circumstance in which a patient satisfies NICE guidance but does not satisfy the criteria in this policy does not amount to exceptionality.

             

10          Force             

10.1       This policy remains in force until it is superseded by a revised policy or by mandatory NICE guidance relating to this intervention, or to alternative treatments for the same condition.             

10.2     In the event of NICE guidance referenced in this policy being superseded by new NICE guidance, then:

• If the new NICE guidance has mandatory status, then that NICE guidance will supersede this policy with effect from the date on which it becomes mandatory.
• If the new NICE guidance does not have mandatory status, then the CCG will aspire to review and update this policy accordingly.  However, until the CCG adopts a revised policy, this policy will remain in force and any references in it to NICE guidance will remain valid as far as the decisions of this CCG are concerned.

 

Date of adoption:      05 September 2019

Date for review:         05 September 2022​​​​​