• Service reviews planned to cut “long tail” of providers doing small amounts of specialised work
  • Prosthetics, spinal cord injury and paediatric burns services could be reconfigured in 2017-18
  • STPs must set out plans for collaborative commissioning with NHS England in cancer, mental health or learning disabilities

NHS England is planning more service reviews in a bid to reduce the “long tail” of providers doing small amounts of specialised work.

According to NHS England’s specialised commissioning intentions, services which could potentially be reconfigured in 2017-18 include prosthetics, spinal cord injury and paediatric burns services.

The intentions also reveal that NHS England envisages a greater role for sustainability and transformation plan footprints in commissioning specialised services.

In recent years discussion about improving care and driving out savings in specialised services has often centred on reducing the “long tail” of NHS trusts that carry out relatively small amounts of ad hoc work.

NHS England buys specialised services from 300 providers, but just 20 account for around half of its spending, while 250 providers take 20 per cent of the spend.

Sir David Nicholson, the previous NHS England chief executive, proposed centralising services into 15-30 centres.

Last year the national commissioning body announced a rolling programme of “strategic service reviews”, and in July its review of congenital heart defect services recommended decommissioning services at three trusts.

NHS England’s specialised commissioning intentions, released as part of the 2017-19 planning guidance, include a renewed effort to cut the long tail by networking services or moving them.

“Where the relationship between quality, value and patient volumes is strong we expect there to be consolidation of some services as a consequence of undertaking reviews,” it says.

Service reviews that might result in reconfiguration in 2017-18 include:

  • Hyperbaric oxygen therapy – a service involving breathing pure oxygen at higher than atmospheric pressures in an enclosed chamber to restore damaged cells and organs
  • Prosthetics
  • Spinal cord injury
  • Paediatric burns
  • Children’s epilepsy surgery
  • Metabolic medicine
  • Intestinal failure
  • Paediatric review of critical care and transport, surgery and ECMO – a machine used for babies with severe heart and lung failure

The document reveals that NHS England is not intending to transfer responsibility for any of the 149 existing specialised services to clinical commissioning groups, although it said it wanted clinical commissioning groups “to take a greater role in planning and commissioning” them through collaborative arrangements. However, it does envisage a greater role for STP areas.

NHS England said it would commission services at three levels: nationally, regionally, and on an STP or multi-STP level, with 20 services earmarked for the latter.

For 2017-18 and 2018-19 all STP footprints will have to implement collaborative commissioning arrangements in at least one of NHS England’s priority service areas: cancer, mental health and learning disabilities.

The intentions also require STPs to set out “how the specialised commissioning spend can be increasingly joined up from April 2017 with wider local health system spending to improve outcomes and value across the whole care pathway for those services”.

“For more advanced and higher performing CCGs and STP footprints we will test feasibility of joint commissioning and delegation arrangements with NHS England,” the document adds.