Specialised commissioning

Changes to the commissioning of specialised services

NHS England has commissioned specialised services since its inception in 2013. There are 154 different specialised services which are generally accessed by comparatively small numbers of patients serving catchment populations of usually more than one million. These services tend to be located in larger hospital trusts that can recruit a team of staff with the appropriate expertise and enable them to develop their skills.

The NHS is making changes to how some specialised health services are planned and delivered.

Plans to delegate suitable specialised services were first set out in the May 2022 via the Roadmap for Integrating Specialised Services within Integrated Care Systems | NHS England. This was enabled by the legislative provisions in the Health and Social Care Act 2022. In December 2024, the NHS England Board reaffirmed plans to delegate commissioning responsibility for 70 specialised services to the six ICBs in the south east of England from 01 April, 2025, to the value of £2.3bn.

All ICBs have signed a ‘Delegation Agreement’ which sets out the formal and legal transfer of commissioning responsibility. (Add link to ICB Board page where this is approved.) NHSE will remain the accountable commissioner for the delegated specialised services.

NHS England will therefore, continue to set consistent national standards, services specifications and clinical commissioning policies; develop metrics and quality dashboards to support improvement, oversight and assurance; and, provide national clinical leadership, expert advice and support to ICBs through its Clinical Reference Group infrastructure.

What does this mean for patients?

Delegation of 70 specialised services aims to improve patient care, reduce waiting times, and ensure people in South East England get the best possible treatment when they need. For example it will:

• enable the planning, commissioning and provision of better and more integrated services for patients across whole and linked pathways of care;
• support key aims of the government’s forthcoming ten-year plan to bring about a shift from sickness to prevention; and from hospital to community;
• enable ICBs to act as strategic commissioners of specialised services, with providers increasingly reaching into neighbourhood health and care systems.

The role of Surrey Heartlands in the commissioning of specialised services

The strategic commissioning of specialised services will bring opportunities for NHS Surrey Heartlands Integrated Care Board from 01 April, 2025.

Through delegation and ICBs taking on new commissioning responsibilities, we have a significant opportunity for a renewed focus on the ‘left shift’ agenda, enabling access to care closer to home as well as integrating specialised and non-specialised pathways improve the health and well-being of patients across the southeast.

A new, statutory joint committee arrangement is being established so that our ICB, along with the other five ICBs in the south east, can effectively work together to discharge our new specialised commissioning responsibilities. The scope of this multi-ICB joint committee will be wider than Specialised Commissioning, and will include other areas of joint working important to all ICBs and provide a formal link back to our own ICB Executive Board, which has a statutory responsibility for our local population.

Reporting to this, a Specialised Commissioning Sub Committee will ensure that decisions are made collectively across the six South East ICBs, rather than taken independently. This reflects the interdependencies of patient flows across South East ICBs, as there is not a single specialised commissioned service where patient flows are contained to the boundary of a single South East ICB.

Together, this joint committee will agree the clinical priorities where we can jointly make the biggest difference to our patient population. For more information on the governance, please visit our ICB Board Meetings page to see how this was approved (paper 06 19th March 2025 meeting).

In light of the recent announcement to integrate NHS England into the Department of Health and Social Care, NHS England are working through the long-term future arrangements for the 84 specialised and highly specialised retained services, which are not being delegated at this time.

For more information on the delegation of specialised commissioning please visit NHS England » Specialised Commissioning – update on specialised services for delegation.

Quality of patient care

ICBs and providers to have freedom to design services and to innovate in meeting the national standards where they take on delegated or joint commissioning responsibility.

• Patients will receive more joined up care better communication and sharing of information between professionals and services.
• More of a holistic, multi disciplinary approach to care. A range of professionals can be involved in planning a patient scare.
• Increase focus and investment on prevention.
• Patients will receive the right care at the right time in the right place.
• Better step-down care to support patients who are ready to leave specialised care.

Equity of access

ICBs and providers able to pool specialised budget and non specialised budgets to best meet the needs of their population, tackle health inequalities and to join up care pathways for their patients.

• Population based budgets means decisions on spend are based on the needs of a local population the demographics, health behaviours rather than on activity in hospitals.
• Specialised clinical expertise will have a role in managing population health and to challenge underlying drivers of health inequalities.
• Providers and professionals working collaboratively, free from organisational constraints and commissioning boundaries, will help improve quality of care and tackle unwarranted variation.
• Opportunity to level up access across the country.

Value

ICBs and providers able to use world class assets of specialised services to better support their communities closer to home. For example, designing local public health initiatives, greater diagnostics and screening.

• Investment in preventative care could reduce demand for specialised services.
• Providers and professionals can better manage patient demand, even when one part of the system becomes stretched. Patients can be re-directed or transferred so they have faster and better access to treatment
• A whole system approach creates opportunities to protect and build workforce resilience, as shown during the pandemic.
• Pooled or delegated budgets allow underspends to be shared or reinvested and avoids commissioning pressures on any one organisation.

Outcomes

1. Accessible care
2. Tailored care
3. Seamless care
4. Effective care
5. Preventative care