Briefing / The delegation of specialised services to local commissioning

Purpose of this briefing

Commissioning specialised services has long been a complex area and is currently going through a period of change due to delegation. This briefing is for information; supporting finance and other professionals working outside the commissioning/contracting process to understand more about the changing landscape for commissioning specialised services.
The briefing explains the background for the purchase of NHS specialised services in England, leading to the decision to improve pathway management by delegating commissioning for a range of services from NHS England to integrated care boards (ICBs). The briefing then explains the process of delegation, including the choice of services, timescales and ongoing governance arrangements. 

Introduction

The NHS in England is primarily funded by public monies via allocations from the government to the Department of Health and Social Care (DHSC) based on the outcomes of the parliamentary spending review. Funding is allocated to NHS England, most of which is passed to ICBs, which commission services from NHS and non-NHS providers of healthcare for local populations.NHS England, Delegation of NHS England’s direct commissioning functions to integrated care boards, May 2022  Some services are commissioned directly by NHS England as they have been designated as specialised, needing an expert, national approach.
The services commissioned by NHS England specialised commissioning department are those needed for a small number of individuals with rare conditions, where the expertise is only available at a small number of organisations; or where larger services require national expertise and decision-making on behalf of a wider number of organisations. For the rare conditions, there will be only a small number of patient events per year, but for services such as radiotherapy and neurosurgery there may be tens of thousands of patient events per year. 
Specialised services are designated as such nationally, in conjunction with clinical and management expertise in the national programmes of care (NPOC). The specialised commissioning list of servicesNHS England, NHS commissioning specialised services, accessed May 2024  has changed over time: new services are added for recently identified conditions or where there are new or expensive components to the care pathway. Occasionally, some services have moved from central to local commissioning. 
The Health and Care Act 2022UK Parliament, Health and Care Act, 2022  with its introduction of ICBs and collaboration of partners within integrated care systems (ICSs) reflects an intention for greater control of commissioning decisions at local level.  This has led to a plan to moveThe term used in the guidance and in this briefing is to delegate the commissioning responsibility, as the overall statutory responsibility for commissioning remains with NHS England.specialised commissioning responsibility for some services from NHS England to ICBs, allowing the care to follow the nationally established service specifications but enable greater operational control to achieve the desired outcomes. The delegation and ongoing commissioning of these services will remain governed by the terms set out in the NHS payment schemeNHS England, NHS payment scheme 2023/25, accessed May 2024 (NHSPS) and the NHS standard contractNHS England, NHS standard contract 2024/25, accessed May 2024.

The rest of this briefing is available to HFMA members and affiliates only.