Responsibility for commissioning some specialised services, such as chemotherapy and renal dialysis, could be handed to clinical commissioning groups as part of an NHS England review.
The review – in its very early stages – is considering which services currently commissioned by the organisation should no longer be classified as specialised. Chemotherapy and renal dialysis are understood to be two of the services whose classifications are currently being reconsidered.
The review comes after NHS England chief executive Simon Stevens told MPs on the Commons health committee that specialised services were currently “overdefined”.
Specialised services, which are supposed to be high cost and low volume, are considered to be too expensive for individual CCGs to commission.
HSJ understands that the original rationale for classifying chemotherapy as specialised was the high cost of some of the drugs used in the treatment. Renal dialysis was included because it was part of the pathway that leads to a kidney transplant.
There is also speculation that radiotherapy could be handed back to CCGs, as it had not been included as a specialised service under the previous commissioning regime. However, the high capital cost of the equipment makes this unlikely.
A decision to move radiotherapy out of specialised commissioning would be likely to face resistance from the clinical community, which had supported its classification as specialised.
Decisions about which services are classed as specialised rests with the health secretary after receiving advice from the Prescribed Specialised Services Advisory Group.
The group is made up of representatives from CCGs, NHS England and the royal colleges.
NHS Clinical Commissioners’ leadership group co-chair Amanda Doyle told HSJ the split between what CCGs were responsible for and what fell to NHS England had felt a bit “arbitrary” in some cases.
However, she said CCGs did not think there were “significant [treatments] which shouldn’t be specialised”.
“People are not saying we should have a return to the old system… What we need are effective systems for collaboration and co-commissioning some of these pathways.”
The definition of specialised services was broadened dramatically when responsibility for commissioning them was handed to NHS England under the Health and Social Care Act 2012. As a result of this expansion, the number of service areas in the specialised category increased from 34 to 75 and included chemotherapy and renal dialysis.
Chemotherapy is currently provided in more than 130 centres, and renal dialysis in 52 centres, most of which also operate satellite haemodialysis units.