Should specialised services pay the ‘price’ of NHS changes?

Former chancellor Norman Lamont infamously said unemployment was a price “worth paying” for low inflation.

The leadership of the NHS is now too politically savvy to make similarly blunt statements but that does not mean it has not decided what “price” will have to be paid to make sure scarce funding is focused on desired change.

The tacit message of the service’s marching orders for 2015 – delivered as normal in a giant document dump in the weeks before Christmas – was that NHS England, Monitor and the NHS Trust Development Authority are prepared to let specialised services, and therefore specialist providers and many large teaching hospital trusts, take a hit.

The clearest illustration of this is the proposal to cap payments for increases in some, often very expensive, specialised treatments under a new marginal tariff.

Be realistic

NHS England would point out its budget for specialised commissioning will receive a large increase, but in the context of current growth and overspending, this is the minimum required to be “realistic”.

The centre would also stress that for proposed service change to be achieved, specialised care will need to play its part.

‘The guidance confirms the shifting responsibility for overseeing much specialised work towards CCGs’

However, the models of care prioritised in new planning guidance for “prototyping” – and supported through funding pots created from the government’s spending boost – focus primarily on transforming out of hospital care and “creating viable smaller hospitals”.

Politics heats up

The guidance also confirms the shifting of responsibility for overseeing much specialised work towards clinical commissioning groups.

‘Delivering NHS England’s new version will spark fierce debate before new year is out’

This change to CCGs holding budgets for whole populations is proposed so they can prioritise spending on preventive measures and earlier intervention, therefore avoiding the need for specialised care.

Because of this, and genuine concerns about expertise in commissioning, the plan has met resistance from specialist clinicians and patient groups.

High profile political rows over accident and emergency and GP access will largely keep this issue out of the spotlight until the summer – something the centre is facilitating by shunting key decisions until after the election.

But whether the country is prepared to pay the “price” the NHS leadership proposes for delivering its new version will spark fierce debate before this new year is out.