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Definition of Exceptionality

For exceptional treatment cases to be authorised for NHS funding, they must be found to have exceptional clinical circumstances and there should be robust clinical evidence to support the treatment in question. The South Staffordshire CCGs have defined exceptionality as some unusual clinical factor (or factor affecting the clinical condition) about the patient that suggests that they are:

  • Significantly different to the general population of patients with the condition in question
  • Likely to gain significantly more benefit from the intervention than might be expected from the average patient with the condition

The fact that a treatment is likely to be efficacious for a patient is not, in itself, a basis for exceptionality.

If a patient's clinical condition matches the 'accepted indicators' for a treatment that is not funded, their circumstances are not, by definition, exceptional.