Specialised services face £5bn gap

The commissioning of renal dialysis and some parts of neuroscience services are being transferred back to CCGs.

These areas, alongside chemotherapy, secure mental health services, neonatal intensive care and neurosurgery have driven half of the annual growth in NHS England’s specialised services budget.

James Palmer, NHS England’s clinical director of specialised commissioning, told the Foundation Trust Network conference this week that specialised services would see a £5bn funding gap by 2020 if spending growth continues at current levels.

He added that the national body would now prioritise addressing the growth in the six highlighted service areas.

“It’s only six service areas that count for 50 per cent of all that growth,” he added. “We don’t need to set up a whole new commissioning structure; we need to focus on six clinical services to deal with growth.

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“[They are] chemotherapy, secure mental health, renal dialysis, neurosciences and neonatal intensive care.”

Mr Palmer put the specialised services growth rate at 7 per cent.

“If you apply that average growth rate just in specialised services there’s a £5bn gap in five years.”

Under its former chief executive Sir David Nicholson, NHS England had proposed centralising specialised services into 15 to 30 centres across the country.

Mr Palmer said this should now be consolidated into 18 centres, based on the assumption that no patient should have to drive more than an hour to get to a services.

“Once you get to about 18 [centres] – it fixes as being a reasonable time frame to get to a specialised service.

“We’re not in the situation of commissioning to 15-30 specialised centres. But we’re emerging from detailed thinking about this. Where there is clinical evidence we should continue to do so.”