Specialised services are a vital part of NHS care. For people with rare or complex conditions, the care and technical expertise of these services can be life changing or lifesaving. These services also play an integral part in the NHS's interactions with the research and innovation sector and hence contribute to economic growth.
NHSE's proposals to enable statutory ICSs and partners to plan and shape many of these services based on local needs and priorities is an important milestone in the development of system working but the jury is still out as to whether the majority of specialised services, can and should, be effectively devolved either in joint arrangements with NHSE or under a fully delegated arrangement. Trust leaders discern both opportunities and risks in the implementation which they are keen to manage proactively. While the local implications of these changes are likely to vary across systems and trusts, trusts are keen to address questions around clinical input to local decision making, how to minimise any potential for fragmentation associated with more local specialised commissioning, and ongoing resource prioritisation for specialised services.
Looking ahead, trusts are making the case for a flexible approach to the implementation process – ahead of, and subsequent to, April 2023 – which will give them and their partners the best chance to make the changes work. In the near term, this includes clear communication of decisions and expectations to facilitate timely planning within systems and joint committees. In addition, it includes a commitment from national bodies to ongoing evaluation of impacts (recognising a potential for unintended consequences), supporting local systems to develop planning arrangements that make sense based on their contexts, and an approach which can empower trusts delivering specialised services to innovate, including working through provider collaboratives where appropriate.
We are grateful to have had the opportunity to engage with NHSE as these plans have taken shape. Over the coming months, NHS Providers will be continuing to work with members to interpret and influence national decisions around the transition and supporting the sharing of ideas and local approaches.