Archive of: 2010
The Specialised Healthcare Alliance has been working with the NHS’s regional Specialised Commissioning Groups (SCGs) to look at services which have been prioritised by the National Specialised Commissioning Group in relation to QIPP (Quality, Innovation, Productivity and Prevention – a policy which aims to deliver quality and productivity at a time of spending constraint). The Alliance has organised eight service specific stakeholder workshops in conjunction with the relevant lead SCG. These have been uniformly well attended with strong representation from clinicians, other healthcare professionals, commissioners, patients and patient groups.
The service specific reports on blood and marrow transplantation, haemophilia, HIV and spinal cord injuries, available below, are informed by the discussions which took place at each workshop. An Executive Summary in each report outlines key findings and recommendations. A further batch of four reports will be posted shortly.
The Specialised Healthcare Alliance held its second national conference at the Royal Society of Arts on 16th November. Earl Howe, Minister for Quality at the Department of Health led an impressive array of speakers, while the audience included extensive representation from inside and outside the Alliance’s membership, including nine of the 10 regional Specialised Commissioning Groups.
Although uncertainty remains around the commissioning environment which will emerge following the White Paper, there was considerable consensus around certain key issues including:
- The need for the doctor/patient relationship to evolve in a way which taps into the ability of many patients to help inform both diagnosis and care, especially in the field of rare conditions and co-morbidities;
- The role of patient organisations in protecting the vulnerable and driving up standards, sometimes through the provision of more innovative services;
- The need to ensure integrated pathways, whether through financial mechanisms or other means such as multidisciplinary networks;
- The potential contribution of NICE quality standards or their equivalent to specialised care;
- The value of patient registries, with more sharply focused datasets helping to keep down costs.
All were agreed that the quality of specialised services will be a litmus test for the NHS as it seeks to find savings.
The Alliance has responded to the coalition government’s White Paper “Equity and excellence: liberating the NHS”. The response welcomes the proposal to place responsibility for commissioning national and regional services as defined by the National Definitions Set with the proposed NHS Commissioning Board. This has the potential to address a number of shortcomings in current arrangements, as identified by the Health Select Committee in March (see below). There are, however, a number of important matters requiring clarification.
The Alliance has published a report on England’s new approach to commissioning health services, products and technologies for small patient populations. This includes recommendations calling for:
- clarity about the criteria determining whether a product or technology will be assessed under the new arrangements or by NICE. These might be expected closely to reflect the new Advisory Group on National Specialised Services’ decision-making framework;
- transparency in the process, so that all parties can see the major factors influencing decisions about which products and technologies should attract funding;
- a holistic approach, which demonstrably weighs all the complex considerations governing health gain, societal value, reasonable cost and best practice;
- robust regional arrangements for those services, products and technologies neither suitable for commissioning at national nor local level;
- ethical consistency in decision-making across the NHS drawing on the framework as a template.
Companies also need to show responsible commercial behaviour in responding to society’s wish to help people with very rare conditions in great clinical need.
At a crucial time for the future of specialised services, the Alliance is delighted to announce a top line-up of speakers for its conference on 16th November looking at how to deliver the best quality of care for people with rare and complex conditions during a time of financial constraint.
The conference is aimed at a broad audience and will be seeking to deliver some tangible progress towards core quality standards for specialised services covering issues like diagnosis, treatment, care, commissioning and outcomes.
The Specialised Healthcare Alliance is pleased to see that the White Paper (Equity and excellence: liberating the NHS) published on 12th July provides for national and regional specialised services to be commissioned by the proposed National Commissioning Board, rather than GP commissioning consortia. In particular, this approach has the potential to address the current shortcomings in regional commissioning identified by the Alliance in its evidence to the Health Select Committee earlier in the year.
Clearly, there are important issues which remain to be addressed and these will be picked up by the Alliance in its formal response but the White Paper represents an encouraging development for specialised commissioning.
The Alliance hosted a special session on 24th June at the NHS Confederation Conference in Liverpool. The speakers were Professor Rod Griffiths, Chair of the National Commissioning Group and Nicolaus Henke, Director of McKinsey’s health practice. Professor Griffiths focused on the new ethical framework which has been developed to support decisions about national commissioning of services, products and technologies. Mr Henke touched on the proposed new shape of commissioning arrangements in the NHS and highlighted the increasingly specialised nature of healthcare. Members of the audience agreed that the ethical decision-making framework broke important new ground and could be of value to the wider NHS.
After its successful gathering in 2008 on high cost treatments, which helped to inform the development of an ethical decision-making framework for national commissioning, the Alliance is holding a second conference at the Royal Society of Arts in London on Tuesday 16th November. This time attention will focus on delivering quality in the downturn. Early speakers include Earl Howe, Minister for Quality and Paul Corrigan.
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The Health Select Committee’s report on commissioning has now been published and includes an important chapter on specialised services, providing important backing for the Alliance’s analysis of the strengths and weaknesses of current arrangements. In particular it:
- Acknowledges significant improvements in specialised commissioning since the Carter Report of 2006;
- Highlights the regulatory limbo occupied by SCGs and the threat posed to funding for specialised services as NHS funding is squeezed;
- Recommends that the Department of Health undertake a review of the problems surrounding implementation of Carter, taking into account the Alliance’s proposal that regional Specialised Commissioning Groups should be re-located within Strategic Health Authorities and funded directly.
p.The Alliance is delighted that Sir Liam Donaldson has taken the opportunity of his last annual report as Chief Medical Officer to highlight the importance of rare diseases both in terms of their frequent severity and the cumulatively large number of people affected. Sir Liam’s recommendations chime with the Alliance’s call to renew and reinvigorate the Carter reforms, proposing to:
- Strengthen the network of reference centres for rare diseases to enable better coordination of specialist services, including the transition from paediatric to adult services.
- Ensure that adequate numbers of specialists are trained so that future service needs can be met.
- Appoint a National Clinical Director for rare diseases to oversee the development of clear standards and pathways for the treatment and surveillance of rare diseases, with national registers to support service planning and delivery as well as research.
- Strengthen research, including translational research with economic incentives, to develop and market medicines for the ‘orphan diseases’.
- Raise public and professional awareness of this neglected group of diseases.
- Support international collaborative efforts to share information and resources for rare diseases.
The Specialised Healthcare Alliance was joined by other witnesses on 14th January in giving oral evidence to the Health Select Committee about specialised commissioning. The Alliance believes that the evidence submitted by a wide range of witnesses has borne out the importance of robust specialised commissioning structures at regional and national level, along with the need to renew and reinvigorate the Carter reforms.
The results of the Alliance’s survey of SCGs which helped inform its evidence to the inquiry have also been collated.
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