The new Handbook to the NHS Constitution gives us information on how to appeal a blanket ban on T3.

[holyshedballs]

page 48 of the Handbook to the NHS Constitution it says:

“You have the right to expect local decisions on funding of other drugs and treatments to be made rationally following a proper consideration of the evidence. If the local NHS decides not to fund a drug or treatment you and your doctor feel would be right for you, they will explain that decision to you.”

The Handbook goes on to say:

"For such decision-making, it is important that the process is rational, transparent and fair. This right ensures that there is such a process".

I think that the PrescQIPP and the ROMC recommendations are none of these. PresQIPP and the RMOC are legally bound to have regard to the Constitution, so this is a argument in "our" favour, if we can work together to provide body of evidence to show that the PrescQIPP and ROMC recommendations are not rational e.g. T4 is not a substitute for T3 and that they have not been fair e.g. they are heavily biased and poorly researched with selective excerpts from BTA statements to recommend that absolute opposite of what the BTA recommend.

The Handbook also says:

"In addition, decisions by the courts have made it clear that, although an NHS commissioner (which since 1 April 2013 includes a local authority commissioning public health services) can have a policy not to fund a particular treatment (unless recommended in a NICE technology appraisal recommendation or highly specialised technology recommendation), it cannot have a blanket policy; i.e. it must consider exceptional individual cases where funding should be provided."

Clearly any CCG that operates a blanket ban is contravening the decisions by the courts and the NHS Constitution.

Further, on page 10, the handbook clearly states:

Patients and staff are in many cases also able to seek legal redress if they feel that NHS organisations have infringed the legal rights described in the NHS Constitution. For patients and the public, this could be in the form of a judicial review of the process by which an NHS organisation has reached a decision.

[MaisieGray]

Having regard to, means only that; it doesn't mean must or must not. You can have regard to something ie consider it, when deliberating on your policy, and still go against it. "It must consider exceptional cases" is in the same vein.

[holyshedballs in reply to MaisieGray]

The courts have been clear that if there is a legal duty for a public body to have regard to guidance then that public body should follow that guidance unless it has a good reason to deviate from it. Ali v London Borough of Newham 2012 and R (Rose) v Thanet Clinical Commissioning Group 2014 spring to mind. Just not liking the guidance is not a good enough reason.

Similarly there is strong case law, as mentioned in the Handbook to say that blanket bans are unlawful. That is what the Handbook says. Please read it, on page 50 of the Handbook. See my previous post for the case law. When guidance says "must" or "shall", particularly in the Handbook, that is an instruction. So "It must consider exceptional cases" is an instruction.

These are all reasons for Judicial Review as detailed by the Handbook. Failure to have regard to the Constitution can be used as evidence in court hearings.

[MaisieGray in reply to holyshedballs]

Yes I've read it. and that was my point - follow guidance "unless it has a good reason to deviate from it". It is not an absolute rule, it allows for action or decisions which are other than, where there is a valid or justifiable reason not to comply. I neither said nor implied that "just not liking the guidance" is a good enough reason - I lectured in housing and charity law for many years and understand concepts of compliance, guidance , exception etc.

[holyshedballs in reply to MaisieGray]

Yes you are right as I said that a public body can deviate from guidance if it has a good reason to do so. the judge in the Thanet case said that simply not liking the Guidance in not a good enough reason to deviate from guidance. The irrational PrescQIPP and RMOC recommendations are not rational transparent or fair yet they both allow the special exemption. Perversly, the CCGs ignore the BTA guidance, the BTA follow up statement the PrescQIPP recommendation that switching should be patient specific and does not mention a ban, NHS England guidance to CCGS allows special exceptions and does not mention a ban and the new RMOC recommendations allow for special exceptions and do not mention a ban. So the CCGs do not have a good reason to deviate from the guidance.

this means that their decision are not rational as required by the Constitution and clarified by the Handbook.

So why are you saying that the Handbook removes information that allows us to appeal with drawl of T3 when it clearly does give that information? Plus the case law that blanket bans are unlawful is clear and the Handbook confirms that?

[Hashihouseman]

That's exactly what I meant about using the overarching aims and commitments of the NHS, its raison-dletre, what used to be called patients charter, to challenge unfair and obstructive positions like the RMOC 'advice' to GPs etc.. which create an almost universal 'blanket' approach through its aggressive confrontational attitude.

NHS position and internal advice to prescribers etc. should encourage / allow positive prescribing not seek to establish negatory attitudes and barriers for example it could make full spectrum healthy thyroid output ie. up to 20% of likely T3 production and 100% of likely T4 production available as exogenous replacement prescription.

In cases where Significantly greater amounts of exogenous T3 are already being relied on or there is persistant low free T3 (despite physiological T4 replacement) and lack of thyroidal wellness (Symptoms of hypothyroidism not largely resolved) then perhaps there should be a strategy of offering patients liothyronine and levothynxinne with referral to endocrinology specialists for Support in accurate dose titration and balance of replacement T3 and T4 according to individual needs. Ongoing in that would be more thorough differential diagnosis and more comprehensive, more frequent blood testing for lingering symptoms and low range T3 despite T4 would be a simple, easy, cheap place to start. Some simple gene tests to discover any known potential thyroid system polymorphism could also be selectively applied and data amassed nationally to allow retrospective epidemiological studies as well as help individual prescribing.

As it stands the endocrinology community is learning nothing by it's closed luddite attitude to thyroid hormone illness and treatment and patients are mistreated, unsupported and left to fend for themselves sometimes with unlicensed dubiously sourced costly replacement therapies which should be freely available and safe as reasonably possible.