Specialised Services Commissioning into 2008

1. Specialised Services Commissioning into 2008 Karen Helliwell - Director Specialised Services West Midlands

2. What are specialised services? “Specialised services are an important but often complex and costly part of the portfolio of services provided by the NHS” Sir David Carter, Chair of the Review of commissioning arrangements for specialised services (May 2006)

3. ………….It is estimated that specialised services account for about 10% of total PCT expenditure on hospital services. Totalling £3.48 billion in 2004/05

4. Specialised Services -Characteristics • Planning population above one million • Provided in few specialist centres • Support specialist staff • Sustain clinical competence • Support research • Scarce resources • Very fast developing areas – Rapid change or development – “leading edge” • Often low volume but high cost • Require co-ordination & integration with other key specialties

5. Which services? • Specialised Services National Definition Set (2nd Edition) • 35 services identified / detailed descriptions • Supposed to be an “Iterative process” – redefining definitions as services become mainstream • 3rd Edition – consultation process underway. • Eventually all services will be commissioned by Specialised Commissioning Teams

7. Carter Review • Need for simpler commissioning structures – 10 SCGs • Integration with other PCT collaborative functions • Co-ordination at National level • NSCG/NCG • Uniform approach/ consistency across country [improved collaboration]

8. West Midlands Arrangements West Midlands Strategic Commissioning Group £700M Shropshire Staffordshire LCCB Pan Birmingham LCCB Specialised Commissioning Team (West Midlands) Coventry /Warwick LCCB Black Country LCCB Hereford/Worcester LCCB 17 PCTs

9. Challenges • Rapid growth in new technology/drugs • Finite level of resources • Prioritisation of investment across all PCT services • Integration with PCTs /PBC and their local agenda • “World Class” Commissioning of specialised services

10. Key Issues : a series of polarities • Access v relevance to population • Health improvement v individual intervention • Evidence base and effectiveness over time • Opportunity costs : e.g. Herceptin v stroke care; Avastin / Lucentis v welfare benefits • Role and funding of research, appropriate mix health services cradle – grave • Bringing promising technology into practice and de-commissioning outdated – angioplasty v surgery, primary angioplasty v thrombolysis • Concentration of expertise, safety of practice and outcome v access and public expectation • What we each want as patients v what we each contribute as tax payers

11. Management of New Technology/Drugs • Closer collaboration/working across 10 SCGs • Development of expertise/early warning of new technology • Clear business cycle/process for decision-making • PCTs/SCGs – robust policies on trial pick up/orphan drugs

12. Next Steps for Specialised Commissioning • Robust needs assessment for services. • Clear service models • Specifications for services [what commissioners require] • Designation of providers for specialised services • Clear standards/clinical outcomes of investment • Openness and transparency on prioritisation of investment