The national standardisation of specialised services could prompt a wave of reconfiguration and destabilise smaller trusts, it has been claimed.
From April, responsibility for the commissioning of specialised services worth £12bn, or about 10 per cent of the NHS budget, will rest with the NHS Commissioning Board.
The board’s consultation on draft service specifications for 120 services, including specialist cancer services and most vascular services, is due to close next week. On 11 January the board published a further seven specifications including severe asthma and ophthalmology, which are open for consultation until 22 February.
Trusts which do not currently meet one of the standards − which include staffing levels and minimum levels of activity − will be allowed to apply for a “derogation”, delaying the requirement to an agreed date. If they have not met the standard by the agreed deadline they will no longer be able to provide the service. The derogations will be signed off by the commissioning board.
There is no pre-set limit on the time but board clinical director for specialised services James Palmer told HSJ derogations would not be allowed to become the status quo.
Speaking at the Specialised Healthcare Commissioning Alliance conference last week, commissioning board director of corporate commissioning Ann Sutton acknowledged it would mean the board addressing some “really challenging issues”.
“I think we are going to get [situations] where providers are providing a little bit of the service that it may no longer be appropriate for them to provide,” she said.
It is hoped this national approach will remove “postcode lottery” variation of access and standards of services across the country.
However, the proposals have sparked concern among some NHS leaders − particularly of small trusts − about how any of the changes will be handled.
The chair of one small hospital trust told HSJ: “The ramifications of not planning it all very carefully could be quite a destabilising effect on [district general hospitals]. It could have an impact on medical training… how do you reconcile running a 24/7 DGH with losing services?”
The source also said the changes could spark public campaigns: “To prevent [public protests] all over the place we are going to have to have a really sensible time frame.”
NHS Confederation deputy policy director Jo Webber told HSJ the health service needed to explain to the public that smaller hospitals could still provide aftercare, even if they lost some specialised services. She cited the example of service changes made by trauma networks in recent years.
University College London Hospitals Foundation Trust chief executive Sir Robert Naylor told HSJ the new arrangements would accelerate the “rationalisation” of specialised services which is already taking place to improve outcomes.
He said, as a major regional centre, his trust did not see the NHS Commissioning Board’s plans to “reshape” large teaching hospitals as a threat. “We don’t see it as a challenge. Our expectation is that it will increase the amount of work we do rather than surgeons doing incidental cases at DGHs.”