Health and care needs in England are changing, as people increasingly live longer with multiple conditions. Organisations across the NHS, and wider partners, are working together through integrated care systems (ICSs) to join up services to better meet these needs, and support people to stay well wherever possible.

The Health and Care Act 2022 placed ICSs on a statutory footing from July 2022 by establishing integrated care boards (ICBs) to commission NHS services and establishing integrated care partnerships (ICPs) to plan to meet the wider health, care and wellbeing needs of populations. Over winter 2022/23 ICSs are developing strategic priorities for the next several years via integrated care strategies and joint forward plans.

In this context, NHS England (NHSE) is progressing plans to change how specialised services – a portfolio of around 150 services accessed by people often with rare or complex health needs (see below for more detail) – are commissioned. From April 2023, NHSE plans to give local systems a bigger role in planning and shaping many specialised services. This will be enabled through two routes – either by NHSE working with ICBs to jointly commission services or by NHSE delegating responsibility and budgets to ICBs for those services.

Specialised services already draw on a range of capabilities – multidisciplinary teams of health professionals with specialist knowledge and experience, purpose-built equipment and facilities, and innovative technologies and therapies. They also serve smaller patient populations. In consequence, specialised care is often comparatively cost intensive. NHSE is also progressing proposals to change how funding is allocated to ICBs for specialised services by introducing a population needs-based allocation mechanism.

In light of these developments, this briefing aims to:

  • Outline the changes NHSE plans to implement from April 2023; and provide some preliminary analysis of the benefits and risks inherent in greater system leadership of specialised services. It is informed by extensive engagement with both trusts and NHSE. It is published as systems and national bodies prepare for implementation in 2023/24 with a view to sharing trust leaders' analysis of the opportunities these changes offer, foregrounding some risks which must be addressed, and informing decisions around transition planning. While our analysis inevitably captures a trust perspective on the proposed changes, it remains essential that national policy makers continue to engage users of specialised services as specialised commissioning policy evolves.

Specialised services

Specialised services are a diverse portfolio of around 150 services generally accessed by people living with rare or complex conditions. These include services for people with physical health needs, such as cancer, neurological, and genetic conditions, and some mental health problems such as adults with eating disorders and children and young people with complex mental health needs. These services are often delivering cutting edge care informed by latest developments in medical innovation and are correspondingly costly. While in many cases treating relatively rare conditions, collectively the specialised services portfolio delivers care to large numbers of people. In 2022/23, specialised services were allocated around £22.9bn nationally, roughly 15% of the overall NHS commissioning budget.

Specialised services are delivered by a range of trusts, including specialist trusts focused on particular clinical areas or patient groups, and some tertiary centres that deliver specialist services alongside more common physical or mental health care. It is common for providers of specialised services to deliver care to patients living across large, multi-ICS geographies.