- Integrated care boards (ICBs) are taking on a bigger role in commissioning specialised services. From 2023/24, they will plan many of these services via joint working arrangements with NHS England (NHSE) and from 2024/25 they are expected to take on delegated functions and budgets for some services.
- Trust leaders are committed to working with NHSE and ICBs to make new arrangements work. However, they see opportunities and risks in the proposals, the impact of which will vary depending on populations, geographies and how specialised services are currently delivered:
- In some services, trust leaders see opportunities to join up care more effectively by taking an end-to-end view of pathways across specialised and non-specialised services.
- Trust leaders are enthusiastic about provider collaboratives enabling trusts to work with commissioners in new ways and play a leading role in driving better care and value. Greater local leadership of specialised services could be provided by trusts working together in provider collaboratives and learning from progress in the mental health sector.
- However, ICBs are new organisations, taking on an extensive portfolio of responsibilities and will need to ensure they are ready to provide the focus and prioritisation which commissioning specialised services will require.
- ICBs will need to ensure they have the right capabilities and relevant expertise, much of which is currently concentrated in NHSE. Trust leaders will also want to be sure that there is no increase in administrative burden for trusts delivering these services as they shift from working with NHSE to dealing with multiple commissioners. - It is important that a move to more local planning of specialised services does not lead to a loss of the patient and clinical insights that inform specialised commissioning so constructively today.
- Specialised services will also need appropriate financial prioritisation – across both revenue and capital funding – to sustain high quality care for patients and support innovation.
- Changes to specialised commissioning need to be implemented in a way that supports innovation and does not unintentionally either reduce the NHS's capacity to innovate, or erode its contribution to economic growth by pioneering new treatments and technologies.
- Any substantial change programme can have unintended consequences. It is vital that NHSE works with trusts and system partners to manage the transition process and to understand and evaluate the full impacts of these changes, on outcomes and resources, over time.