Daily Insight: Systems face a specialised test

Delegating specialised commissioning from the centre to integrated care systems has long been heralded but discussions on this topic have hitherto been short of details, such as which services are to be delegated.

Yesterday, that changed. NHS England put out guidance that said 65 of the 154 services currently commissioned by NHSE are ready and suitable to be devolved to the ICSs. The list covers a range, from adult congenital heart disease services to tier 4 child and adolescent mental health.

The rest will remain with NHSE. For some, this will be only temporary. They are seen as suitable for delegation but are not ready yet because, for example, “a programme of significant national service change is under way”. Meanwhile a third tranche will stay with NHSE; they are considered unsuitable to be devolved and include the highly specialised services that are for a few hundred patients a year.

This is only half the story, however. Next, NHSE must decide which of the 42 ICSs are ready and able to take on the responsibility.

That decision will come in February after an assessment process. We must wait to see which of the new bodies are deemed fit for the task.

Virtual wards need real evidence

The virtual wards concept instinctively sounds like a winner.

Hospitals can free up much-needed beds, while also removing often vulnerable patients from and sometimes dangerous, but always expensive, acute environments.

But some experts argue the evidence simply does not support the concept. 

Alison Leary, professor of healthcare and workforce modelling at London South Bank University, cited a study, to be published in June in the journal, eClinicalMedicine, part of the Lancet, to underline her concerns.

It said it found “no evidence of early discharges or changes in readmissions associated with the rollout of covid virtual wards across England”.

Meanwhile, an HSJ reader highlighted another study just out, in the well-respected New England Journal of Medicine, which reported similar conclusions.

NHSE has however put a lot of eggs in the “virtual ward” basket (and £450m) so system leaders obviously believe otherwise.

However, as we reported this week, internal data suggests progress towards a target to have 24,000 virtual beds in place by December 2023 has been sluggish.

Of course, it’s early days, but system leaders will need to secure clinical buy-in to ensure success, and this requires good old-fashioned evidence.