Archive of: 2005
As an early contribution to the review of specialised commissioning set up by Lord Warner in October, the SHCA has prepared a commentary on the terms of reference, as attached. Members have since reinforced many of the points made at a stakeholder day held on 2 nd December. EDM 762 on specialised commissioning has also attracted support from more than 120 MPs so far, demonstrating what will be keen parliamentary interest in the outcome of the review.
The SHCA is pleased to be represented on a Task Force which has been announced by Lord Warner, DH Minister of State, to look at specialised commissioning in the context of wider NHS reforms with a view to making arrangements more robust.
The Task Force is due to report to ministers by spring 2006 and has the following remit:
To ensure that NHS commissioning for specialised services is fit for purpose and robust in the context of NHS system reform.
Terms of Reference
- To review the current arrangements in the NHS for Specialised Commissioning Groups and Local Specialised Commissioning Groups, as set up following DH guidance in 2002 , and the national commissioning under NSCAG and to identify strengths, weaknesses and existing good practice.
- To assess the potential impact of NHS system reform on specialised services and treatments.
- To make proposals for improvement in specialised services and treatments commissioning, which fit with work on Implementing a Patient Led NHS, including what should be commissioned nationally
- Ensure that proposals keep specialised services commissioning in step with wider NHS reforms and generate consistent arrangements across the country.
Early Day Motion
Meanwhile, Doug Naysmith MP has tabled an Early Day Motion (No 762) on the subject of specialised commissioning. This reads:
“That this House notes the large number of people affected by the great diversity of specialised medical conditions; considers that the standard and availability of specialised services is fundamental to a properly functioning National Health Service; recognises the vital role of effective specialised commissioning in delivering a patient-led NHS; and calls upon the Government to ensure that robust funding systems are in place to ensure stable provision for these vulnerable patients.”
The SHCA is keen for as many MPs as possible to sign the EDM as the Task Force gets underway.
A series of policy developments are combining to move specialised commissioning slowly but surely up the agenda, as summarised in the attached paper.
In a debate sponsored by Earl Howe on 11 th July, attention was drawn to the potential impact on specialised services of Payment by Results and Foundation Trusts and to the need for better risk sharing between PCTs . In his response, Lord Warner on behalf of the government undertook to look carefully at specialised commissioning in taking forward wider NHS reform.
In a short debate in the House of Lords on 7 April sponsored by Baroness Barker, Lord Warner, responding for the government confirmed that Standards for Better Health published in July 2004 “covers the commissioning by PCTs of specialised and mental health services” and that the Healthcare Commission’s assessment system will cover commissioning. He continued:
“The Healthcare Commission will be working with primary care trusts in the coming year to develop ways of measuring and assessing commissioning more effectively. The commission is also planning an improvement review into commissioning and, where relevant, it will examine how effectively services are commissioned as part of the review, which will embrace specialist commissioning. The new criteria document that the Healthcare Commission will publish shortly will refer specifically to the needs of specialist commissioning.”
DH Steering Group
The SHCA is pleased to be represented on a DH group looking at ways of strengthening and improving the coherence of the processes for planning, decision-making and performance management at all levels of specialised commissioning within the NHS.
The DH’s strategy for implementing the NHS improvement plan shows pleasing signs of putting specialised services closer to the heart of government policy. In particular, there is a commitment to extending clinical networks in a way which is responsive to patients and can introduce new clinical practices quickly. The Alliance looks forward to working with Strategic Health Authorities and the National Leadership Network for Health and Social Care in taking the policy forward.
In what looks likely to be a general election year, the Alliance has sent its own manifesto to all the main political parties, as attached. In particular, the NHS should be judged by the standard and availability of its specialised services, which affect considerable numbers of people, including some of the most vulnerable in society.
The SHCA is concerned about the potential impact of PBR on the provision and quality of specialised services. In some cases, national tariffs seem inadequately to reflect the extra costs of specialist providers. In others, specialist treatments have been excluded from PBR but may be financially squeezed if expenditure within the scheme overruns. The Alliance is therefore working with the Royal College of Physicians to set up a nationwide monitoring panel of clinicians to act as an early warning system. Aggregated results from the panel will be posted on the website at regular intervals as the year unfolds, commencing in the spring.
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