STPs to set plans for specialised services overhaul

The requirement is part of a strategic framework for specialised services, published by the national organisation this week, less than six weeks before the STP submission deadline at the end of June.

The report, presented to NHS England’s board on Thursday, said all STPs would have to “identify priorities for service change, and design stress-test provider configurations”.

It says “expectations for STP submissions on specialised service planning” include:

• to “agree service priorities”;
• identify the “appropriate level of planning identified for services” – often likely to be larger than a single STP; and
• “set out provider model and configuration required to deliver shared STP and NHS England priorities sustainably”.

The plan says that by the halfway point of 2016-17, plans by STPs and specialised commissioning hubs must be “signed off, inclusive of proposed provider configurations and new contracting models”.

NHS England announced ambitious proposals for redesign of specialised services when it took over responsibility for them in 2013, and identified many providers which are not meeting minimum requirements in their specialties. However, progress in addressing this, and developing service change plans, has been extremely patchy.

The plan published this week said: “Previously NHS England has called for consolidation of providers into ‘15-30 centres of excellence’. The new approach recognises that local, regional and national collaboration is required […] to meet different population needs.

“This could still be consolidation of providers into single centres of excellence, but equally a new franchise, chain or network model, being pioneered by vanguard areas, may be better suited to the local circumstances.”

It also proposes moving to new population-based funding models, changes to the relationship between NHS England and clinical commissioning groups, and different approaches to adopting new treatments. It says: “Improving adoption [of new treatments] will mean revisiting [the National Institute for Health and Care Excellence]/NHS England relationship.”

NHS England director of specialised commissioning Jonathan Fielden told NHS England’s board meeting on Thursday: “We will ask [STPs] what is the best provider footprint/configuration [needed] to deliver [services] in the best way for your area and that will lead to some changes.”

Dr Fielden said the move to national commissioning of specialised services in 2013, while it had some advantages, had resulted in some “fragmented” patient pathways which would need to be “linked up”.

The NHS England strategy echoes some of the recommendations recently made by a commission on specialised services, which was convened by the Specialised Healthcare Alliance and chaired by Lord Warner.

Meanwhile, NHS England chief financial officer Paul Baumann told the board that clinical commissioning groups would need to meet “significantly higher” efficiency targets in 2016-17. The average was 3 per cent, he indicated, compared to 2 per cent in previous years.

He said: “Given that all the available funding is being channelled in to the NHS, quite rightly, in the spending review, we have to ensure that we’ve got enough flexibility in our own resources within the NHS to deal with the risks which emerge during the course of the year.”

The need for CCGs to hold a risk reserve of 1 per cent meant they had need to plan for significantly greater efficiencies, he said.