Specialised Commissioning Service Development Policy | NHS England
This service development policy sets out NHS England’s approach for making decisions about which new treatments and interventions to routinely commission, and the approach used for updating existing service specifications, or creating new ones.
It is intended to ensure that funding is allocated fairly and appropriately, with due
regard to the competing demands on NHS England’s available funding.
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
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.
Lancaster H. et al. BMJ Supportive & Palliative Care | Published Online: 28 February 2017
Objectives: Some failures in end-of-life care have been attributed to inconsistent provision of palliative care across England. We aimed to explore the variation in commissioning of services by Clinical Commissioning Groups (CCGs) using a data collection exercise.
Methods: We sent a Freedom of Information request in the form of an open questionnaire to all 209 CCGs in England to assess their commissioning of palliative and end-of-life care services, mainly focused on the provision of specialist palliative care services.
Results: 29 CCGs provided information about the number of patients with some form of palliative care needs in their population. For specialist palliative care services, CCGs allocated budgets ranging from £51.83 to £2329.19 per patient per annum. 163 CCGs (77.90%) currently commission 7-day admission to their specialist palliative care beds. 82.84% of CCGs commission 7-day specialist palliative care services in patients’ own homes and out-of-hours services rely heavily on hospice provision. 64 CCGs (31.37%) commission pain control teams, the majority of whom only operate in regular working hours. 68.14% of CCGs reported commissioning palliative care education of any sort for healthcare professionals and 44.85% of CCGs had no plans to update or review their palliative care services.
Conclusions: The most important finding from this exercise is that the information CCGs hold about their population and services is not standardised. However, information based on data that are more objective, for example, population and total budget for palliative care, demonstrate wide variations in commissioning.
The documents cover the commissioning of public health, armed forces, health and justice and specialised services. They provide practical guidance on the best ways to involve patients and the public and include good practice examples and links to resources.
The report highlights that although NHS England took responsibility for commissioning these services three years ago, it still does not have an agreed overarching service strategy, consistent information from all providers on costs, access to services and outcomes or how efficiently services are being delivered. The report finds that a number of factors are creating financial pressures for specialised services including the increasing volume of effective but expensive new drugs, and increasing demand for these services.