Specialised services are those provided in relatively few hospitals, accessed by comparatively small numbers of patients but with catchment populations of usually more than one million. These services tend to be located in specialised hospital trusts that can recruit a team of staff with the appropriate expertise and enable them to develop their skills.
Specialised services account for approximately 14% of the total NHS budget, spending circa £13.8 billion per annum. The commissioning of specialised services is a prescribed direct commissioning responsibility of NHS England. Four factors determine whether NHS England commissions a service as a prescribed specialised service. These are:
- The number of individuals who require the service;
- The cost of providing the service or facility;
- The number of people able to provide the service or facility and
- The financial implications for Clinical Commissioning Groups (CCGs) if they were required to arrange for provision of the service or facility themselves.
The ambition of NHS England is to bring equity and excellence to the provision of specialised care and treatment. This is achieved through a commissioning process which is patient-centred and outcome based i.e., the patient is central to planning and delivery. Commissioners, working with providers, must deliver improved outcomes for them across each of the five domains of the 2013/14 NHS Outcomes Framework; is fair, consistent throughout the country, ensuring that patients have equal access to services regardless of their location, and; Improves productivity and efficiency.
A nationally consistent and coherent approach to specialised commissioning is built on universal support. To date, there has been wide variation in how each region discharges its commissioning responsibilities. This has resulted in inconsistencies in the management of the commissioning cycle e.g. budget setting, contract negotiation, performance management and the development and application of service specifications, commissioning policies and quality standards. It has also resulted in duplication of some activities and functions.
A consistent approach to central planning that is delivered locally will help to tackle these variations and take positive steps towards raising standards of care for all patients receiving treatment for rare and specialised conditions with equity across the country.
NB> Specialist commisssioning does not apply to Scotland, Wales & N Ireland
SNS for faecal incontinence can only be performed in units recognised by the Local Area Team (LAT). A pre authorisation form needs to be completed prior to a temporary and a permanent implantation being performed. This is to ensure that patients are discussed at a pelvic floor MDT and that the appropriate conservative measures have been followed as per NICE guidelines. There is a CQUIN attached to this which if not complied with, results in a reduction in payment.
Surgical treatments for pelvic organ prolapse are within the specialised gynae clinical reference group. Specialised commissioning services are only involved when there is a recurrent prolapse, or recurrent urinary incontinence. In other words, LVMR for internal or external rectal prolapse is funded, should it be considered appropriate by the local CCG.
Obviously, it would make sense to have one service specification for the specialised commissioning of functional pelvic floor disorders. This must be our aim but there are significant hurdles to overcome before this is achieved. The PFS governance committee working with the Clinical Reference Groups for specialised colorectal and gynae are committed to this goal.