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Difficult Decisions - Help us to Prioritise and Align Clinical Policies

Altogether the six CCGs in Staffordshire and Stoke-on-Trent commission over 800 different services and treatments, but availability of these varies across the area.

Together they have been spending around £2 million more per week than they receive, and that means some difficult decisions now need to be made.

That is why an engagement exercise took place for people to share their experiences of five different treatments. The CCGs wanted to understand the real impact these treatments have on people’s lives before deciding how they should be provided across Staffordshire and Stoke-on-Trent in the future.

The five areas are:


Assisted conception

Hearing loss in adults

Removal of excess skin following significant weight loss

Breast augmentation and reconstruction

Male and female sterilisation

The engagement exercise launched in January 2020 and ended 1 March 2020

Information paper for the engagement exercise (January to March 2020)

Results from engagement period

The experiences and information collated during the engagement period has been independently analysed – this includes feedback from the survey, ‘be a commissioner’ events and information sent from various groups and networks.

Download the Difficult Decisions engagement report, or view the Difficult Decisions engagement summary.


Next steps

This information will help the CCGs create a short list of viable options for access to these treatments across Staffordshire and Stoke-on-Trent, following which a formal consultation will then be held to gather feedback on these options.

As a result of the Coronavirus pandemic, this engagement work has been paused. Read the statement issued in April 2020, and a further statement was issued November 2020.

On 28 January 2021, North Staffordshire Clinical Commissioning Group (CCG) Governing Body met to discuss a recommendation which affects the commissioning policy that sets the eligibility criteria for NHS funded hearing aids for adults with hearing loss. The Governing Body approved to remove any restrictions for patients with moderate hearing loss on this policy.


This means a small change in the Difficult Decisions programme going forward. The programme will not include the hearing aids for moderate hearing loss for North Staffordshire as it is being addressed through the commissioning policy. Therefore, all six CCGs in Staffordshire and Stoke-on-Trent will only include hearing aids for those with mild hearing loss. The work remains paused due to the continued efforts needed to fight the Coronavirus pandemic and rollout of the vaccine.


Read the full stakeholder briefing pdf here (796 KB) .