Trust leaders will seek to maximise the opportunities of localised specialised commissioning arrangements – whether joint working arrangements or delegation – in partnership with ICBs. They are committed to realising the benefits of system working and see real opportunities to work together across traditional boundaries to improve care for patients and communities.
NHS Providers has a long-standing interest in specialised services spanning both mental and physical health services. We work closely with other provider membership bodies, including the Federation of Specialist Hospitals and the Shelford Group, to monitor, interpret and influence national policy around specialised services. Over the last several months, we have worked with members to understand a range of trust leaders' views regarding the implications of statutory ICSs playing a bigger role in specialised commissioning. We have represented trusts' views in the provider implementation reference group as part of NHSE's programme delivery architecture for the changes to specialised services. In 2023, we will continue engaging with members, partners and policymakers to further explore how to create the most favourable conditions for the transition to a more localised model of specialised commissioning.
As implementation proceeds, trust leaders would welcome a focus on monitoring and evaluation of the impacts of the changes to specialised commissioning. The areas outlined below merit sustained attention:
- Care quality. NHSE is rightly maintaining its role setting standards around specialised services are to flourish, their financial resourcing – spanning revenue and capital – will, at least, need to maintain its relative prioritisation over time in the face of many competing service priorities. ICBs and partners will want to work together to ensure that their local decisions, informed by input from NHSE, do not see other priorities unintentionally crowd out necessary investments in specialised services.
Enabling provider collaboratives to maximise their value. Trust leaders see real opportunities to improve care for local populations through working in provider collaboratives. Moving to a more localised model of specialised commissioning presents further opportunities for providers and commissioners to work together in new ways, with collaboratives acting as a possible vehicle to bring together their capabilities and focus them on service improvement and transformation. Mental health collaboratives, many of which are working through lead provider models, have taken steps in this direction.
- Capacity for innovation. NHS care is constantly evolving as new technologies and techniques are incorporated into clinical practice. Specialised services, often delivered in centres of clinical excellence, are the crucible of many of these developments, pioneering cutting edge techniques supported by bringing together multidisciplinary teams leading research, education and service delivery. Trust leaders are emphatic that the NHS's long-term ability to deliver outstanding care – and support economic growth – is partly dependent on continued innovation. National policymakers must ensure that these changes to commissioning arrangements facilitate this, and do not unintentionally contribute to an operating environment which is less conducive to innovation.