In order to access tertiary/specialist care, individuals must apply for funding through a referral pathway. Funding referrals are actioned by the local Community Mental Health Team (CMHT), so individuals must be under the care of this team at the time of referral. There are a few different funding pathways that can be used to secure funding for specialist treatment, depending on where you live and what service you need.
The three main funding routes are:
- Funding through the local Health Board/ICB, also know as ‘National Specialist’ (available in England, Wales, and Northern Ireland)
- Funding through NHS England, also known as Highly Specialised Services/HSS funding (available in England and to Scottish residents wanting to access treatment at a specialist service in England)
- National Services Division of NHS Scotland (funds the specialist OCD service at the Ninewells hospital in Dundee for Scottish residents
We have also included some brief information on Patient Choice/Right to Choose below for those living in England, which can be used to access non-specialist treatment with CADAT at the Maudsley hospital via a GP.
Please note: We now refer to ‘National Specialist’ funding as ‘Funding through the local Health Board/ICB’ across all of our resources. These two terms refer to the exact same funding route and some services may still refer this pathway as ‘National Specialist’.
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Which funding route is right for me?
Below, you can click on your area to see what funding options are available to you, and which might be most appropriate based on your individual situation.
You can access tertiary/specialist treatment through funding to your local Health Board.
You can access tertiary/specialist treatment through funding to your local Health Board.
You can find more information in the appendix about the service at the Ninewells hospital on our Tertiary care page.
Please note – the flowchart below can act as a rough guide to the options available. To get a clearer idea of which option best suits you, you can refer to the details about individual specialist centres on our Tertiary care page. You can also read about the funding options in more detail below.
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Funding pathways
Each local area has a designated local Health Board that makes decisions about what services to ‘commission’, or pay for. In England this is called the Integrated Care Board (ICB), formally known as the Clinical Commissioning Group (CCG). It may still be called the CCG in your area. When someone needs an assessment or treatment from a service outside their local area, the local Health Board must approve it first. The idea behind this is that your local area won’t pay extra for a service that isn’t needed, so you and your CMHT need to show that it is.
An application for funding made to the local Health Board/ICB is the ‘traditional’ referral pathway and is led by your consultant at the CMHT. In very rare cases, this can be done by a GP or other professional.
Your CMHT consultant would make an application for funding to your local Health Board/ICB to the specialist service you would like to be referred to. Depending on your area, this application might be called an IFR (Individual Funding Request). You can find tips about putting together a strong funding request on our Funding requests page.
The funding needs to be approved by the local Health Board/ICB so that you can be seen by the specialist service chosen. This could be done in two stages (assessment and then treatment) or all at once.
Usually people will need to have “exhausted local provision” first before being referred on for specialist care through this funding route, which means that they will need to have accessed enough local treatment to justify needing to go out-of-area.
NHS England has a designated ‘pot of money’ that it can use to fund the treatment of the most serious and hard to treat cases, rather than the local Health Board/ICB funding it. NHS Scotland contributes to the pot, so Scottish residents wanting to access treatment at a specialist centre in England are also eligible. This referral must be made by the local CMHT.
This pathway has much stricter requirements than others, but anyone who meets them will have the funding approved. To meet the criteria for this funding, you must meet all three of the following:
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- A high score on an OCD or BDD scale
30 or above on Y-BOCS (for adults with OCD) and CY-BOCS (for children with OCD)
36 or above on the BDD-YBOCS (for people with BDD)
OR Your CMHT consultant can also provide a statement about how severe your symptoms are instead of a score - Unsuccessful treatment through therapy
2 rounds of ‘adequate’ CBT with ERP (for adults)
1 round of ‘adequate’ CBT with ERP (for children) - Unsuccessful treatment through medication
1 round of an SSRI (for children)
2 rounds of SSRIs, plus a round of augmentation, (for adults with OCD)
2 rounds of SSRIs (for adults with BDD)
OR if you are unable to take a full round of medication (3 months) because of your condition or because of the side effects you experience, the medication requirement can be dropped on a case by case basis
- A high score on an OCD or BDD scale
The National Services Division of NHS Scotland funds the specialist OCD service at the Ninewells hospital, in Dundee. This means that treatment at this service is already funded for Scottish residents who are eligible. For more information on eligibility criteria for the Advanced Interventions Service, please see the appendix in our Tertiary care page.
Patient Choice or Right to Choose is a legal right under the NHS England constitution, which allows patients to choose where they want to receive treatment. Basically, if you could access it locally, you have a right to access it anywhere else in England and your ICB will pay for it. This referral is made by a GP and not by the CMHT, as it does not involve accessing specialist treatment.
Technically, this option can’t be used for specialist-level treatment, because it has to be for something you could access locally. Luckily, CADAT at the Maudsley hospital offers treatment at all levels, including primary and secondary. This means that you can get a Patient Choice referral to their ‘non-specialist’ services, where you would still be treated by therapists who are experts in OCD.
This funding can only be used for a single round of therapy from CADAT, with no ‘extras’. So if you need support while you are waiting for treatment (for example, home visits from a mental health nurse or crisis support to keep you safe) then this is not an appropriate option.