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‘Trailblazer’ ICSs needed to pave road for specialised services, thinktank says

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By Jess Hacker
19 May 2022

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NHS England should consider delegating specialist services to matured ‘trailblazer’ Integrated Care Systems (ICSs), a thinktank has said.

The report, led by Policy Exchange, suggested that pushing responsibility for services ‘away from the centre and into ICSs’ would allow local leaders to better tailor them to their populations.

NHS England is required by the Health Secretary to commission all 149 prescribed specialised services.

However, Policy Exchange warned that the specialised commissioning portfolio is too large to delegate in one motion, and should be taken in stages.

It comes after amendments in the Health and Care Act, which passed into law last month, allowed for the delegation of commissioning responsibilities to England’s 42 ICSs, with NHS England expected to publish a delegation roadmap in the coming months.

The Policy Exchange report suggested that NHS England should initially focus on the more commonly used services – such as chemotherapy or specialist mental health – where there is a high level of interface with the larger system.

It said: ‘The NHS should also consider delegating services initially to a small number of ‘trailblazer’ ICSs which have reached organisation maturity. All delegation must involve close collaboration with the existing NHS regional teams.’

However, the thinktank warned that the majority of ICSs are ‘immature organisations adjusting to new ways of working’, adding that allowing services to be delegated to a single, or multiple, ICSs in one region, but not in another could result in ‘a confusion of roles and responsibilities’ with ‘paralysing effect’.

NHS England should announce its intention to pilot delegation amongst a small set of services from April 2023 ‘at the earliest’, it said, and should include services like dialysis, chemotherapy, specialist adult cardiology, and mental health.

It added that the budget for specialised commissioning has grown by more than 50% from 2013 to 2020, with taxpayer spending expected to rise by £5bn to £25bn by 2025.

The report also referred to a recent NHS Confederation report, led by Sir Chris Ham, which called for regional offices to become ‘thinner’ as ICSs take on more responsibilities.

The Policy Exchange authors agreed there is a risk of losing of expertise in commissioning specialised services in empowering ICSs.

That report, published in February, also warned that bureaucratic central leadership could threaten NHS reforms, arguing that decision-making in the NHS should instead start ‘at the most local level possible’.

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