Commissioning board extends control as 'specialised' budget balloons

The NHS Commissioning Board confirmed the figure today, after a number of senior commissioning sources told HSJ that the specialised commissioning budget would increase substantially next year.

It means that some acute services previously commissioned locally by primary care trusts will in future be commissioned centrally by the board, rather than by clinical commissioning groups.

The £12bn is 41 per cent higher than the specialised commissioning figure for 2011-12 of £8.5bn. The new figure is made up of budgets for services previously commissioned on a regional basis by specialised commissioning groups, and others which were the responsibility of PCTs.

Definitions of specialised services were widened earlier this autumn to cover services previously commissioned locally, such as all radiotherapy services and all chemotherapy drugs.

All cardiac surgery activity, and all vascular services except those for varicose veins have also been newly defined as specialised services.

From 2013-14, specialised services will be commissioned by the board through its network of 27 local area teams. It is intended that there will be no local variation in what is commissioned so entitlements do not vary across the country.

NHS commissioners noted that the definitions of specialised services were widening to include services – such as vascular and cardiac surgery that are either already provided on networked basis or are increasingly expected to be networked.

However, one senior source told HSJ that it amounted to a “central land grab”. Another said: “People in clinical commissioning groups think they will be commissioning the same acute services as PCTs – but there will be a major shift into local area teams.”

HSJ understands that many clinical organisations including royal colleges have been anxious to centralise the commissioning of services such as surgical specialisms or mental health treatments.

However clinical commissioning group leaders are concerned by the move. NHS Clinical Commissioners interim chair Charles Alessi said the issue needs “further clarification”.

“While it is right we get an accurate figure as to what has actually been spent in the NHS on specialised services there is a potential problem between centralisation and devolution,” he said. “The worst situation is that CCGs have accountability while decisions are taken elsewhere.”

The board said its commissioning function will be clinically led and will end potentially controversial “postcode lotteries”, in which services were denied to patients in some parts of the country but not others.

A spokeswoman said: “The improved system will ensure national consistency in accessing services, reduce variation, and set clear quality standards leading to better health outcomes for patients.

“The central involvement of medical and nursing directors with the input of expert clinical and expert patient networks will ensure that national standards can be delivered locally.

“These services will be reviewed on an ongoing basis to reflect changes in treatments, clinical evidence and innovation.”