Is your local health and care system and integrated care board ready for commissioning specialised services?

From 1 April 2023, Integrated Care Boards will take on an expanded role in the planning and commissioning of specialised services. NHS England is changing how specialised services – a collection of 154 services accessed by people with often rare and complex health needs and delivered by a range of trusts - are commissioned.

Under plans confirmed by NHSE at its board meeting last week, it will delegate commissioning responsibility for 59 services to statutory joint committees formed between NHSE and multi-ICB collaborations across nine regions. 

It will move to delegated commissioning arrangements from 2024/25 subject to a “further assessment of system readiness”.

The nine geographical footprints that will oversee and take commissioning decisions from April can be viewed here. NHSE heard that 40 ICBs are planning to establish formal joint working arrangements with only two ICBs in South London identified as ready to take on more responsibility for specialised services.

NHSE’s final list of services suitable and ready for greater ICS leadership can be viewed here of which:

• 59 services (£13bn) are ready for ICB leadership in April (they range from adult specialist ophthalmological services to specialised allergy services for adults and children);
• 29 services (£1.5bn) that are suitable but not yet ready for greater ICB leadership including services in scope of Mental Health Learning Disability and Autism Provider Collaboratives; and
• 89 services (£1.3bn) that will remain nationally commissioned, including all 78 highly Specialised Services, such as heart and lung transplantation services.

It says that these figures exclude budgets for high-cost drugs, devices and other national programmes which will continue to be held centrally.

Supporting NHSE’s plans, it is also changing how funding is allocated to ICBs for specialised services by introducing population needs-based allocation mechanism from April, with the gradual introduction of a new needs weighted allocation formula from April 2024. NHSE has confirmed that throughout 2023/24 the money and financial liability will remain fully with them.    

In light of these developments, NHS Providers has produced a comprehensive briefing, Specialised Services and system working: risks and opportunities for the sector. Its publication is timely as systems and national bodies prepare for implementation with the first set of joint commissioning arrangements for services ‘go live’ in April.

Over the recent months, NHS Providers has engaged with trust leaders to understand how they are preparing for this change and what impacts, opportunities and risks this presents to patients, services and organisations including the newly established ICBs. You can read NHS Provider’s analysis here.

If you’d like to discuss any of the issues raised here, do contact Rob Day and Rhian Vandrill.