Archive of: 2013
The Health Service Journal has published a comment piece by the Director of the Specialised Healthcare Alliance on the funding arrangements for specialised services.
The article provides an overview of the budgetary difficulties that have beset NHS England in the first months of its commissioning of specialised services, including the avoidable topslicing of additional funds for specialised services from Clinical Commissioning Groups just a few months after the new arrangements took effect.
If the promise of the new commissioning arrangements for specialised services is to be realised, with service standards levelled up for patients uniformly across the country, action urgently needs to be taken. NHS England must ensure that resource is properly allocated to activity and that funding for specialised services moves towards a genuine national risk share, in order to achieve both value and quality in specialised commissioning.
The article is online here and reproduced here: HSJ article on specialised services funding 20131212
Between June and October 2013, the Specialised Healthcare Alliance held meetings with each of the 10 Area Teams with responsibility for specialised commissioning. The Alliance sought to gain a better understanding of how the new arrangements for specialised services were working in practice and to discuss the challenges and opportunities which lie ahead.
A summary of the findings from this series of meetings has now been published. Amongst the key observations from the meetings were:
• the urgent need to communicate the merits of the new arrangements to CCGs and HWBs;
• the importance of developing accurate budgets and to avoid mid-year top-slicing which could inflame those relationships and potentially prejudice patient care;
• the need to clarify the role of Area Teams in patient and public engagement;
• the weak nature of relationships with area representatives on CRGs.
The summary report is available here: SHCA Area Team Meetings 2013 – Summary of Findings
The Department of Health has now published the UK Strategy for Rare Diseases in response to an EU Council Recommendation on the subject from 2009.
The SHCA was part of the Rare Diseases Stakeholders Forum which fed into the development of the Strategy, and welcomes the Strategy’s vision for a joined-up approach to services for people with rare conditions across the UK. The Alliance is pleased to note that the Strategy reflects several of the recommendations from its 2011 report, Leaving no one behind, concerning issues such as diagnosis, networks and the role of registers.
By the end of February 2014, each country of the UK will need to develop a national implementation plan. This will naturally be an important focus over the coming months, with a view to ensuring that the Strategy’s commitments can be realised in the context of different health systems.
The UK Strategy for Rare Diseases is available here
As part of the development of the five-year strategy for specialised services, NHS England and the Specialised Healthcare Alliance are inviting individuals and organisations to provide written submissions to inform the strategy’s scope. A briefing document has been prepared to help guide those interested in making a written response, which will form the basis of a scoping report to be prepared by the end of this year.
The briefing document can be found here, and written responses should be submitted no later than 13th December 2013.
As reported in July, the Alliance is delighted by NHS England’s decision to develop a strategy for specialised commissioning in the period to 2020, building on the seminal Carter Report. We are now pleased to be working with NHS England to ensure that stakeholders from all quarters have an opportunity to help inform the scope of the exercise, both through written submissions and a special event in London on 9th December.
Initial information is set out in a joint press release, which can be found here.
1st October sees the implementation of NHS England’s national service specifications for specialised services with providers in England. Providers now need to comply with national standards for specialised services, eliminating any significant variation in services across the country. While fairly widespread, time-limited ‘derogation’ from these national standards is expected in the first year of operation, the objective of uniform service provision for all patients in England is a step closer to being achieved.
The Alliance has been supportive of the move to national commissioning of specialised services as a means of levelling-up quality across the country and eliminating unwarranted variation in service standards or access to treatment. Confirmation in recently published specialised commissioning intentions for 2014/15 and 2015/16 that NHS England intends to use specifications for the purpose of service improvement is therefore welcome.
NHS England has now launched its long-awaited programme of Commissioning through Evaluation (CTE). The SHCA strongly welcomes this important programme, which reflects longstanding Alliance policy and has the potential to bridge the gap between the available evidence base for promising products and technologies and the production of a national clinical commissioning policy.
CTE will provide for limited commissioning of a specified product for one to two years with a view to gathering and assessing its outcomes in order to form a national clinical commissioning policy. Such a policy would then see the treatment available to all eligible patients in England, or to fall outside of routine NHS funding, on the basis of the evidence generated through CTE.
Six treatments have so far been identified as the first CTE projects, with further products expected to follow if CTE is effective.
Full details are available here: http://www.england.nhs.uk/2013/09/26/com-through-eval/
The Specialised Healthcare Alliance has submitted a response to the Department of Health’s recent consultation on its proposed refresh of the Mandate to NHS England.
The Alliance’s response welcomes the retention of the objective relating to NHS England’s direct commissioning in the proposed refresh, noting the importance of holding NHS England to account for this approximately £25billion of spending.
However, the SHCA’s response also urges the Department to preserve the approach of its first Mandate in setting overarching objectives for NHS England to achieve, rather than particular targets, which could have the effect of distorting longer-term service planning.
The SHCA’s response to the consultation can be found here: SHCA Response to DH Mandate Consultation 201309
Sir David Nicholson has launched NHS England’s Call to Action, which seeks to develop proposals for meeting the challenges facing the health service over the next decade and beyond. A core part of this Call to Action is the pledge to develop a five-year strategy for specialised services, to be published within a year and to contain hard-edged commitments for the first two years of its duration.
The Alliance strongly welcomes this announcement, which has the potential to build upon the seminal Carter Report on specialised commissioning from 2006 to reflect the new context of national specialised commissioning. While much progress has been made against Carter’s recommendations, there is presently a clear need to take stock of what remains to be achieved and to describe a vision for the future development of specialised commissioning under NHS England.
The SHCA will be taking a keen interest in the development of this strategy and will work with its members and others to support NHS England in taking this important work forwards, bringing together relevant expertise where required.
The Call to Action can be viewed here: http://www.england.nhs.uk/2013/07/11/call-to-action/
In April 2013, NHS England published a suite of interim generic policies on cross-cutting issues for its direct commissioning activities, including policies on in-year service developments and the management of Individual Funding Requests (IFRs) for treatments.
The Alliance has produced a short guide based on the interim IFR policy and the associated Standard Operating Procedures in consultation with NHS England. The document covers NHS England’s intended approach to managing and processing treatment requests.
NHS England’s generic policies took immediate effect in April on an interim basis, with a swift review promised in due course.
The Specialised Healthcare Alliance has produced a two-page summary of the changes to specialised commissioning brought about by the Health and Social Care Act 2012. It provides an introduction to specialised services and explains the new commissioning arrangements, which took effect in April 2013.
The Specialised Healthcare Alliance held its third biennial conference on 8th January 2013 in Westminster. A full report of the event, which was addressed by Sir David Nicholson, NHS Commissioning Board Chief Executive, Rt Hon Stephen Dorrell MP, Chair of the Health Select Committee, and James Palmer, Clinical Director for Specialised Services, amongst others, is now available.
Many of the challenges and opportunities highlighted at the conference are expected to guide the Alliance’s activities in 2013, its tenth anniversary year, as the new arrangements for specialised commissioning come into effect.
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