The Specialised Healthcare Alliance (SHCA), reflects on the first six months of specialised commissioning delegation and the lessons that healthcare leaders can take away for the future
In the midst of a changing landscape for specialised commissioning, it is increasingly important that patients stay on the map.
April last year marked a major milestone in the transformation of specialised services, as responsibility for commissioning some specialised services – those deemed ‘suitable’ and ‘ready’ – was delegated from NHS England (NHSE) to Integrated Care Boards (ICBs) in three regions across England.
As a coalition of over 130 charities and corporate supporters that represent patients with rare and complex conditions, the SHCA has been keen to understand how these changes have impacted services on the ground, and most importantly how they are shaping patient experience. This is what we explore in our new report, Specialised commissioning delegation: Learnings from the first six months, and lessons for the future.
With all ICBs set to take on commissioning powers for a larger set of specialised services from 1 April 2025 onwards, the next few months are crucial – we hope that the findings of our report can help NHSE and ICBs plan for success.
Delegation opportunities
With the new commissioning arrangements, specialised services will no longer be siloed – meaning ICB commissioners will have greater oversight across the whole patient pathway.
This presents opportunities to join up care for patients in a way that couldn’t be done before, and also empowers commissioners to explore new models of delivering specialised services closer to home. These changes could enhance patient experience and outcomes but will require ICB commissioners to take initiative and mobilise their new powers.
Our report highlights that there is also potential for improving prevention efforts. With all elements of the pathway joined up under a single commissioner, it will be easier to identify where earlier intervention can be prioritised to prevent a patient’s condition worsening to the point of requiring specialised services.
While improved prevention is a significant opportunity, it is important that the needs of patients with rare and complex conditions – those who will likely always require specialised services – are not lost in the efforts of achieving outcomes for the wider population.
It is clear from speaking with ICBs that there are significant opportunities presented by the delegation of specialised commissioning, and we hope that if there is buy-in and commissioners are willing to seek out and capitalise on these opportunities, then we will begin to see improved patient care in the not-too-distant future.
The risk of unwarranted variation
From 1 April 2025 all ICBs will take on specialised commissioning responsibilities, yet we know there is variation in the knowledge and expertise of different ICBs, with some having more institutional experience than others, as well as variation in the specialised services that are actually delivered in each ICB footprint. Many ICBs are grappling with a lack of headspace or capacity for specialised commissioning due to the challenges presented by immediate operational pressures.
In addition, if we look at those ICBs that have already taken on commissioning responsibility for specialised services, each has a unique approach, with different priorities and projects they are focused on.
There is no ‘one-size-fits all’ approach to delegation and it’s right that ICBs have the freedom to respond to the needs of their populations – but it’s also important to mitigate against the risk of introducing unwarranted variation in patients’ access to, and experiences of, specialised services.
For the delegation of specialised commissioning to be a success, every patient – no matter where they live – should have access to high-quality specialised services that meet their needs. This includes patients with very rare conditions who may rely on treatment from a limited number of specialist centres across the country.
To achieve this, it will be important for NHSE to facilitate information sharing – both within and between ICB footprints – to ensure that all ICBs are brought up to the same standard. NHSE should also make outcomes data publicly available to help patients and the charities that represent them understand how services are performing and where improvements could be made.
The key to success will be collaboration
As charities prepare for a tricky shift from engaging with a small specialised commissioning team at the national level, to soon engaging with 42 ICB commissioners, they are concerned about their limited capacity to do so, and the lack of formal mechanisms to facilitate patient and public involvement (PPI) at the local level.
Our charity members tell us that a major barrier to engaging with ICBs is just being able to get their foot in the door. Not only does this make it difficult to address any specific concerns for patients within these ICB footprints, share their expertise and contribute the patient voice to ICB planning, but it also raises concerns around local transparency and accountability of ICBs.
There is huge value in ICBs taking early steps to build connections with charities and include the patient voice in their planning, to ensure that specialised services are truly reflective of patients’ needs. One easy, practical step that all ICBs can take is making contact details for specialised commissioning leads publicly available, so charities can directly engage with ICB commissioners. We are also calling on NHSE to offer more support to ICBs to help them effectively integrate PPI into their delegation plans.
Ultimately ICBs can’t begin to work on improving the delivery of specialised services in a meaningful way without the patient voice. To make these reforms worthwhile – for ICBs, NHSE and most importantly patients – we urge NHSE and ICBs to unlock the expertise and insight that charities can offer.
