The case for greater transparency in commissioning of specialised services by Paul Fitzsimmons

Commissioning for specialised services is now carried out by the NHS England’s area teams. Currently there are 143 nationally defined specialised services which account for around £11.8 billion of annual spending, or around 10 per cent of the overall NHS budget.

Budgetary shortfalls occur where we see a combination of small and variable patient numbers, scarce clinical expertise and higher costs. This deficit is partly down to the challenge of getting the global sum for specialised commissioning right.  In the current financial year NHS England has again signalled it is heading for a second overspend. In some regions it has already clawed back further funding from local CCGs to cover this and some specialised services may be handed back to CCGs to directly commission to avoid this continuing in the future.

So the message for CCGs is that additional financial pain could be on the way. What should concern CCGs most of all however is they currently have little insight into the scale of the challenge they face. The data on relevant activity for their populations isn’t readily available and there has been varying progress in developing or providing local analytics to help them.

CHKS researchers carried out an analysis using the specialised services assignment adopted by NHS England combined with national HES data to find out the potential scale of financial impact on CCGs. You can find the full analysis on the HSJ website here. We found a significant variation in the volume of specialised services activity. The national average is 1.5 per cent of all finished consulting episodes (FCEs) commissioned on behalf of CCGs every month. We also found a variation in how much the activity above has been charged back to the CCGs despite the fact it qualified as specialised services activity. This varies by up to 4.0 per cent across the country.

Finally we looked at the total cost of the misattribution to individual CCGs (see graph 3). For the majority of CCGs the cost of paying for specialised services activity ranged from just under £0.5m to over £10m. By looking further at one month’s data for the current year for 11 CCGs misattribution ranges from £50,000 to £373,000 per month so a significant financial burden for individual CCGs to bear.

Given our findings, it would seem sensible for CCG finance teams to be independently modelling next year’s expected activity and value based on accurate data around this year’s actual activity (including the misattributions) so they can have a transparent fact-based discussion around future apportionment plans.

Please email us at info@chks.co.uk for the full report and to find out more about how we can support you to drive improvements.

Our analysis contains HES data which is re-used with the permission of The Health & Social Care Information Centre. All rights reserved.Commissioning for specialised services is now carried out by the NHS England’s area teams. Currently there are 143 nationally defined specialised services which account for around £11.8 billion of annual spending, or around 10 per cent of the overall NHS budget.