Lord Warner's Specialised Services Commission Publishes Final Report

An expert commission on specialised services, drawn from across the health service and chaired by Lord Warner, has called for major changes to improve outcomes and efficiency but warned that these alone are unlikely to avoid hard choices about what the NHS can afford without improved funding.

Specialised services costing £15 billion a year encompass everything from severe burns and spinal injury to treatments for cancer and a growing number of rare diseases. As such they are fundamental to a comprehensive health service and essential to keeping British clinical practice in the vanguard of global medicines.

In the wake of a recent NAO report, the commission strongly supports the need for national funding and accountability for these strategic services and sees the associated mandatory national standards as a key means of liberating more local approaches to management and delivery.

In particular, the commission recommends greater freedom for commissioners to work with networks of providers to deliver end to end services for patients’ entire care, enabling them to minimise use of expensive and overstretched hospital resources. New models of remuneration should reflect payment by outcomes for the patient rather than hospital-based activity, underpinned by sound data.

The commission considers that specialised services should play their part in maximising the value of every pound spent by the NHS but doubts that efficiency improvements will be enough to avoid pushing the NHS towards unwanted rationing of services, treatments or both.

Lord Warner comments: “The NHS is a complex eco-system running from general practice through to world-leading centres of expertise and excellence. The commission favours more efficient joint-working through networks, making patients rather than hospitals the hub of care. The current danger is that chronic deficits will progressively impede the range and quality of what the NHS can afford to do. This would have ramifications for patients and this important part of the UK economy alike.”


1. Lord Warner served as a Health Minister in the Blair government from 2003 to 2007 and advised the Coalition Government from 2010 to 2015 in various capacities. He now sits as a non-affiliated peer.
2. The Specialised Services Commission was convened by Lord Warner on the 10th anniversary of the publication of the Carter Review of Specialised Commissioning. The full membership was:

Professor Dame Sue Bailey (Chair, Academy of Medical Royal Colleges)
Professor Maureen Baker (Chair, Royal College of General Practitioners)
Robin Bhattacherjee (General Manager, Actelion – representing the ABPI)
Professor Tim Briggs (National Director of Clinical Quality and Efficiency, Department of Health)
Chris Hopson (Chief Executive, NHS Providers)
Gina Lawrence (Chief Operating Officer, NHS Trafford CCG)
Professor Jane Maher (Joint Chief Medical Officer, Macmillan Cancer Support)
Ed Owen (Chief Executive, Cystic Fibrosis Trust)
Richard Rogerson (Trustee, Niemann Pick UK)
Julie Wood (Chief Executive, NHS Clinical Commissioners)


Deirdre Evans (Director, Scottish National Services Division)
Fiona Marley (Head of Highly Specialised, NHS England)
Daniel Phillips (Director of Specialised Services, NHS Wales)

3. The Commission conducted its work between December 2015 to April 2016 and was assisted by written evidence from a variety of patient organisations, Royal Colleges, industry bodies and companies.
4. The Commission’s recommendations are attached as an Appendix.
5. The National Audit Office published its report into NHS England’s delivery of specialised services commissioning on 27th April 2016. The report can be found here.
6. The Commission has been serviced by the Specialised Healthcare Alliance’s secretariat. JMC Partners currently provides the secretariat to the Specialised Healthcare Alliance.
7. For further information on the Commission’s report, please contact Mark Loughridge (mark.loughridge@shca.info).

Specialised Services Commission – Final Report