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Specialised services worth £600m could be handed to CCGs

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Clinical commissioning groups should be handed responsibility for commissioning specialised services worth more than £600m, NHS England has recommended.


The national body’s commissioning intentions for specialised services in 2015-16 reveal it is seeking to hand over responsibility for renal dialysis and surgery for morbid obesity to CCGs.

NHS England has recommended to the government’s Prescribed Specialised Services Advisory Group that the services should be transferred.

The advisory group, which is made up of leading clinicians, representatives from CCGs and NHS England, and lay representatives, is responsible for recommending to ministers which health services should be classed as specialised, and therefore commissioned by the national body.

If the group agrees with NHS England, it will make a recommendation to the health secretary who can then introduce secondary legislation to make the change in statutory responsibility.

NHS England wants the change to take place in 2015-16. However, it is unclear whether the approval process could happen quickly enough for that to be achieved.

LGC sister title Health Service Journal understands these services have been selected due to their relationship with other services in patient pathways. For example, NHS England’s commissioning policy for surgery for morbid obesity states patients must have attended a multidisciplinary weight loss service before they can be referred. However, not all CCGs commission a service that complies with this policy, meaning some patients have been left in limbo.

NHS Blood and Transplant estimates the NHS spends £677m on renal dialysis annually, while Dr Foster Intelligence found £148m was spent on inpatient spells related to obesity in 2006-07, some of which will have been for bariatric surgery. The total specialised services budget is around £14bn annually.

The commissioning intentions document also confirms NHS England’s ambition to co-commission the majority of specialised services in partnership with CCGs, as reported by HSJ last week.

It said: “NHS England will be establishing arrangements to co-commission the majority of specialised services in partnership with CCGs. This will enable better aligned decision making to help restore pathway integrity and improve the transition for patients between specialised and non-specialised services.

“The detailed arrangements for co-commissioning are being developed and will be shared in due course.”

HSJ understands discussions are ongoing between NHS England and CCG leaders about how this would work in practice with more detail expected in the planning guidance later this year.

A spokeswoman for NHS Clinical Commissioners said its members would support co-commissioning if they were given the resources to do it.

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