Briefing / Roundtable: special case

From April, some integrated care boards will take on full delegation of specialised services. An HFMA roundtable, supported by Boehringer Ingelheim, looked at the practical issues around this major change in commissioning.

The key aim of delegation is to improve integration of services. Since 2013 NHS England has been the commissioner for specialised services – everything from chemotherapy and kidney dialysis through to gene therapies and hand transplants. This has led to improvements with greater standardisation of services and clear clinical access policies.

However, this means that the patient pathway is fragmented, with different commissioners responsible for different parts of the pathway. This can make it difficult for commissioners to invest in upstream services that can improve outcomes and eliminate the need for more significant interventions downstream. Under current arrangements, the investment can come out of one budget, while the benefits are felt in another.

The move to local commissioning of specialised services aims to align the incentives and secure a balance between national consistency and universal access and local decision-making for the benefit of local populations.

With some integrated care boards taking on delegated responsibility for appropriate services from 2024/25, the roundtable explores the benefits of making the change and the challenges that need to be addressed.