NHS Commissioning of Specialised Services

This Commons Library briefing paper looks at the commissioning of specialised services by the NHS in England, for patients with rare or complex conditions | House of Commons Library

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How the commissioning process works is set out in further detail, as well as analysis of the financial management and transparency of specialised commissioning, and recent reforms introduced by NICE and NHS England, including reforms to the Cancer Drugs Fund.

The specialised commissioning budget for 2017/18 is £16.4 billion, 14.9% of the total NHS budget, and is set to rise to 15.8% by 2020/21 to reflect the increasing use of new treatments for previously untreatable conditions.

In its 2016 report, the National Audit Office (NAO) highlighted problems that NHS England had experienced in living within its budget. Some of the reasons for this included an underestimation of the budget required to effectively commission services when NHS England took over commissioning responsibility in 2013, as well as a lack of effective data on how services are commissioned on a regional basis, and problems with effective negotiation of prices with pharmaceutical companies.

This briefing paper looks in details at some of the issues highlighted by the NAO, and recent changes to the commissioning process that allow for a greater degree of cost control.

 

How is the NHS performing?

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This  latest quarterly monitoring report from The Kings Fund finds that NHS is now planning to delay or cancel spending in half of local areas this year to meet financial targets. The survey of NHS trust finance directors suggests that NHS finances have improved over the last quarter of 2016/17 but whilst progress has been made in reducing agency spending, the underlying financial position remains a source of concern with many trusts having relied on one-off actions to improve their financial position.

The 2017/18 financial year looks set to be another difficult one for the NHS. While trust finance directors are more optimistic than at this time last year, 43 per cent of them expect to overspend their budget and a similar proportion (46 per cent) are concerned about meeting financial targets. This lack of confidence extends to the commissioning sector, with only one in five CCG finance leads confident they can achieve financial balance this year.

Full report

Press release

How is the NHS performing?

How is the NHS performing?  Quarterly Monitoring Report | November 2016 | The Kings Fund

The King’s Fund has published How is the NHS performing? November 2016.

This quarterly monitoring report combines publicly available data on selected NHS performance measures with views from NHS finance directors and clinical commissioning group finance leads. The report now also includes views from general practitioners and practice managers, and unpublished activity data.

Additional link: King’s Fund press release

Evaluation of the Rotherham Mental Health Social Prescribing Pilot

Sheffield Hallam University Centre for Regional Economic and Social Research | Published online: 3 November 2016

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Image source: SHU

The Rotherham Social Prescribing Mental Health Pilot was developed to help people with mental health conditions overcome the barriers which prevent discharge from secondary mental health care services. The 12-month pilot – which has now been extended to March 2017 – helps service users build and direct their own packages of support by encouraging them to access personalised services provided by local voluntary and community groups. The pilot was delivered in partnership by Rotherham, Doncaster and South Humber NHS Foundation Trust (RDaSH) and a group of local voluntary sector organisations led by Voluntary Action Rotherham on behalf of NHS Rotherham Clinical Commissioning Group (CCG).

The evaluation of the pilot, carried out by Sheffield Hallam University’s Centre for Regional Economic and Social Research (CRESR), found that it had helped increase the number of discharges from mental health services and improved social and emotional wellbeing of the service users. 156 service users were referred to the pilot, with 136 (87 per cent) taking up one of the voluntary and community services available, such as sports groups, craft classes, cookery courses, swimming, learning programmes, employment skills, yoga, and therapeutic art groups. The research, which was measured against eight different wellbeing outcomes, showed that:

  • 93 per cent of service users made progress against at least one outcome
  • 64 per cent made progress against four or more of the outcomes
  • 39 service users were discharged from mental health services (out of 72 discharge review meetings)

Read the full overview here

Read the full report here

Commissioning groups’ performance on cancer care in England

Edwards, N. (2016) BMJ355:i5554

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It doesn’t look good, but CCGs are only one part of the pathway

NHS England, the body responsible for overseeing local clinical commissioning groups (CCGs), recently published information on how these groups are performing on cancer care. The results were not good. Almost nine out of 10 CCGs were failing (180/209) with only 14% (29) doing well or better.

But beyond the headline figures, these results tell us more about the mess that remains following the 2012 Health and Social Care Act and about how policy makers are running out of ideas on how to make change happen.

The measures cover four indicators. On average CCGs had 50% of cancers diagnosed at stage 1 or 2—showing improvement, but some way from the 2020 target of 62% specified by the independent cancer task force that informed NHS England’s strategy. Only three CCGs came close, with the worst performing CCGs managing just over 30%.

Average one year survival for all cancers is just under 70%, but with a spread of 10 percentage points between the best and worst performing CCGs (64% to 74%). The survival target for 2020 is 75%. Patient experience was high compared with hospital services more generally, at 88%, but varies widely (67% to 96%).

Read the full editorial here