Commissioning in Wales

NHS Wales serves a population of approximately 3 million. Specialised services are overseen at a national level by the Welsh Health Specialised Services Care team (WHSSC) within a strategic framework that sets out the broad aims of ensuring equal access to cost-effective treatments. WHSSC, a joint committee of the Local Health Boards, has four directorates that cover patient care, medical, planning and finance, and corporate services via multidisciplinary Programme Commissioning Teams with six areas of responsibility (cancer and blood, cardiac, mental health, neurological and chronic conditions, renal, and women and children). The Cancer and Blood Programme includes inherited bleeding disorders.

WHSSC has a service specification for inherited bleeding disorders, which it defines as haemophilia A and B, von Willebrand disease and other rare inherited bleeding disorders, but including acquired haemophilia and other related bleeding disorders. The service specification develops the English model of a comprehensive care centre (one in Wales but Welsh patients are also served by two in England) and a haemophilia centre (two in Wales). The document describes the care pathway, standards for service quality and patient safety, and indicators for monitoring performance.

This is complemented by a policy on the management of patients with inherited bleeding disorders including haemophilia, which specifies the type of treatments (but not specific products) that will be funded (prophylactic blood products, on-demand therapy, home delivery, immune tolerance induction, and treatment for the complications of severe haemophilia), the criteria for treatment and how patients should be referred. Requests for individual funding for patients whose treatment is not covered by this policy are covered by a procedure similar to that for England.

WHSSC has also published a policy on the use of emicizumab within its licensed indication. This adopts the commissioning criteria developed by NHS England.