In a rare show of unity so close to a General Election, all parties yesterday (15th January) united in their support for national commissioning of specialised services as the only way to allow consistent standards of access and care. Questions, however, remain about whether NHS England’s plans for collaborative commissioning with Clinical Commissioning Groups (CCGs) are consistent with that unity.
MPs spoke up on behalf of patients with a range of health conditions falling within specialised commissioning and emphasised the view of the overwhelming majority of patient organisations that NHS England’s current plans for co-commissioning specialised services risk returning patients to a ‘patchwork quilt’ of service provision across England.
Shadow Minister Jamie Reed MP (Labour) emphasised the need to retain specialised commissioning at national level and called for the Government to intervene on NHS England’s plans.
For the Government, the Minister Norman Lamb confirmed the Coalition’s commitment to national commissioning and that NHS England’s plans would not detract from national service specifications and standards. However, following the Minister’s remarks, a number of crucial questions remain.
Patient groups are still seeking clarification on the following urgent points:
1. Will NHS England remain the sole budget-holder and accountable commissioner for all specialised services in 2015/16 and future years?
Despite being asked, the Minister did not confirm this and NHS England’s plans to establish ‘place-based budgets’ suggest that pooling of budget and responsibility is planned for 2016.
2. What scope will joint committees of NHS England and Clinical Commissioning Groups have to deviate from national service specifications for specialised services, in 2015/16 and future years?
The Minister said that national service specifications would remain in place, but CCGs have made it clear that they are not bound by their provisions. If joint committees cannot deviate from these specifications, their impact is likely to be limited. The Minister and NHS England need to clarify this matter one way or the other.
3. Patients and their representatives have called for stability in specialised commissioning but the Minister only spoke of NHS England ensuring stability ‘in the transition to the new arrangements’
Patients and the public have indicated their opposition to further changes to specialised commissioning structures. Stability is best achieved by strengthening the existing national commissioning processes.
4. What engagement has taken place on the document NHS England is committed to publishing this month with full details of co-commissioning?
Neither the Specialised Healthcare Alliance (SHCA) nor its members have been involved in developing this document. Subsequent consultation is no substitute for co-production. Alpha-1 Awareness is a member of the SHCA.
Following the deep concern expressed in yesterday’s parliamentary debate and the united view of the parties, the SHCA is calling on NHS England to demonstrate that it has no intention of diluting national budget-holding and accountability for specialised services. Furthermore, it needs to involve patients and the public in co-producing an effective approach to collaboration with CCGs consistent with national standards of access and care.