Individual Funding Request Team contact details:
Write to us at
SES&SP CCG
2nd Floor
Marmion House
Lichfield Street
Tamworth
B79 7BZ
Telephone on: 01827 306 124/129/130
Use our secure email:
Or visit our website at:
Patient Statement to the Individual Funding Panel in Support of a Funding Request
All patients or their advocate have the opportunity to submit a personal statement to the Individual Funding Panel in support of their case.Your clinical case will ideally have been made by your consultant or GP through the application form. However, this statement is purely optional and patients who do not submit a statement will not be disadvantaged in anyway.
Please use the space below to inform the Individual Funding Panel how you feel your case is exceptional. You need to outline why you are significantly different from the general population of patients with the same condition to warrant being exceptionaland why this treatment is likely to be of significantly more benefit to you than other patients with the same condition.
However, please note that any reference to social factors for example the fact you might be a carer or have children, will not be considered by the panel. This is because the CCG considers all life to be of equal value and will not discriminate on the basis of age, gender, disability, religion and social status.
If necessary please enclose additional sheets, although we recommend keeping your statement to a maximum of three sides of A4 if possible. Please return your statement to your consultant or GP who gave you this form who will then submit it direct to Individual Funding Request Team with the application form.
Yours sincerely,
The Individual Funding Request Team
Patient Statement
Patient Statement Template
Version 0.1.
* South East Staffordshire and Seisdon Peninsula CCG, Stafford and Surround CCG, Cannock Chase CCG, East Staffordshire CCG
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