Clinical commissioning groups could be asked to co-commission “the bulk” of NHS England’s £14bn specialised services budget, the head of its specialised commissioning taskforce has said.
In an exclusive interview, Paul Watson told HSJ co-commissioning was likely to involve services being commissioned “in partnership” with CCGs rather than NHS England transferring budgets to the local bodies.
He said a small proportion of the specialised services budget would be better “just commissioned by CCGs”, but that highly specialised services would need to be commissioned “once at a national level”.
However, Dr Watson added that “the bulk of services” could be commissioned “at scale but in partnership with CCGs”.
Such an approach could lead to better designed pathways for patients and allow CCGs to “see what is being spent on behalf of their local population”, he added.
“It’s simply not right that essential services such as radiotherapy, cardiac surgery and chemotherapy should be commissioned without CCGs being at the heart of the process,” Dr Watson said.
His comments come as a survey by the Specialised Healthcare Alliance indicated that the overwhelming majority of clinicians and patient groups involved in specialised commissioning do not want responsibility for commissioning their service to be handed to CCGs.
Of the 101 respondents, 90% favoured their service areas staying within specialised commissioning. This rose to 97% among clinicians in clinical reference groups, which were established by NHS England to develop national specifications for specialised services.
While around one in four respondents said they would like to see more collaboration between NHS England and CCGs, only five were in favour of devolving budgets to CCGs.
Only 15 thought pooling budgets was a good idea.
Responding to Dr Watson’s comments, alliance director John Murray said the “key consideration” for specialised commissioning was where the “budget and responsibility lie”.
“If NHS England retains both but works closely with CCGs - as should always have been the case - so much the better,” he said.
“If the waters become muddied in that regard, then we would start to have concerns.”
Charlotte Beardmore, director of professional policy at the Society of Radiographers and a member of the radiology clinical reference group, told LGC sister title Health Service Journal it was essential national service specifications developed by reference groups continued to set the standards for radiology services.
Rosemary Gillespie, chief executive of the Terrence Higgins Trust, echoed her concerns.
She said: “We would need assurance that the quality of services is going to be maintained. We don’t want to see a postcode lottery for people living with HIV.”
Co-chair of NHS Clinical Commissioners Steve Kell said CCGs would be happy to co-commission specialised services if they were given extra resources to do so.
Further details of the arrangements are due to be unveiled in NHS England’s planning guidance for 2015-16, which is expected to be released in early December. This would “set out the financial and organisational aspects of involving CCGs more fully” in commissioning specialised services, according to a paper presented to NHS England’s board meeting last week.