• Advanced health economies invited to bid to take on delegated spec com budget
  • Options include pooled budgets, joint appointments and internal delegation
  • All STPs and ICS to have “advisory role” on new specialised planning boards during 2019-20

NHS England is encouraging bids from advanced health economies which have the “appetite” to take on delegated specialised commissioning budgets.

In a planning guidance document published late last year, it said some “systems want to integrate specialised services even further into local care pathways”, and it will help those that have the “appetite to explore more advanced place based arrangements for specialist commissioning”.

Integrated care systems and sustainability and transformation partnerships are invited to develop and submit a business case to regional specialised commissioning teams about the benefits, before a “national panel” reviews the case. Final approval will be given by one of NHS England’s board committees.

The paper said it had “identified three options which are possible within the current legislative framework” for making it happen. These are: pooled budgets between NHS England and clinical commissioning groups; joint appointments between the two; and internal delegation of NHS England’s statutory responsibilities (the latter is similar to the approach for Greater Manchester’s “devolution” scheme).

The paper, an annex to 2019-20 planning guidance, said a combination of joint appointees and internal delegation could create “genuine place based decision making and could be considered as part of the development of a wider integrated care system or devolution arrangement”.

NHS England is also developing lead provider and alliance contracting models to allow it to delegate specialised commissioning budgets to some providers while maintaining its legal responsibility for the services.

The paper singled out specialist mental health, where large budgets have already been delegated to providers in some areas such as south London. It said mental health new care models “in future will be commissioned via contracting arrangements that allow provider collaboratives to design and manage services in the best way for their population, and re-invest any savings they make in new services”.

This week, HSJ reported a mental health chief executive who is involved in one of the models predicting all specialised budgets in the sector would soon be devolved.

For 2019-20, NHS England also expects every system to take on some specialised commissioning responsibility, with all STPs and ICS taking on “an advisory role on [an] NHS England-led specialised services planning board”.

The document said: “Over the next 12 months setting up or, where they already exist, strengthening these planning boards should be a priority for specialised commissioners and local systems.”

These boards will cover multiple Sustainability and Transformation Partnerships and prioritise services which overlap with more local patches, such as cancer, mental health, learning disability and some renal and cardiovascular.

It said those services that can be commissioned for populations of less than 10 million were the “most suitable for joint planning”, which it estimates could involve 70 different services with a combined budget of £15bn.

The total specialised budget for 2018-19 is £17.7bn.