PARLIAMENTARY WRITTEN QUESTION
Health Services: Costs (7 May 2024)

To ask the Secretary of State for Health and Social Care, what estimate she has made of the cost to (a) integrated care boards and (b) NHS England of commissioning specialised services in the (i) 2022-23 and (ii) 2023-24 financial years.

Asked by:
Karin Smyth (Labour)

The total spend on commissioning specialised services was £22.7 billion in 2022/23 and £25 billion in 2023/24. As formal delegation of specialised services to integrated care boards (ICBs) begins from 1 April 2024, all spend on commissioning these services in previous years has been the responsibility of NHS England, and not the ICBs. For 2024/25, NHS England is delegating £5.3 billion of commissioning resource to ICBs in the three regions, where delegation will begin from April 2024. This figure excludes high-cost drugs and devices spend.

The nine joint committee arrangements arose from a robust process, which included a readiness assessment, the Pre-Delegation Assessment Framework, made between the ICBs and NHS England regional teams, followed by a National Moderation Panel, and final decision taken by the NHS England Board. The NHS England Board papers for February 2023, December 2023, and March 2024 are available, respectively, at the following links:

https://www.england.nhs.uk/wp-content/uploads/2023/02/board-2-feb-23-item-7-delegation-of-spec-comm.pdf

https://www.england.nhs.uk/long-read/specialised-commissioning-2024-25-next-steps-with-delegation-to-integrated-care-boards/

https://www.england.nhs.uk/long-read/specialised-commissioning-update-on-specialised-services-for-delegation/

The process concluded that a transitional year of joint commissioning would offer the most secure and stable transition towards delegation. There is a comprehensive programme structure in place to support the ICBs in the four regions that are working towards delegation in April 2025, to support them in being ready to take on the responsibilities. NHS England is continuing to work alongside ICBs to ensure that delegation agreements are in place, including ensuring appropriate collaborative arrangements are developed to support ICB commissioning of specialised services. These arrangements will be monitored by NHS England through its assurance processes for specialised services.

A webinar series for commissioning staff, including colleagues in ICBs, was delivered in 2023 across different aspects of specialised services, and there are additional webinars planned in 2024. There has been, and will continue to be, local engagement between regional commissioning teams and ICB teams, as the future operating model is co-developed. A suite of support materials has been shared with teams and continues to be updated. As examples, these include: Commissioning Change Management Business Rules; Finance and Accounting Standard Operating Procedure; and the Contracting Standard Operating Procedure.

NHS England develops services specification and clinical policies through its Clinical Reference Groups. There are 250 published service specifications which include clinical pathway, quality, and other relevant standards, which are specific to the clinical service. Regional commissioning teams, overseen by the statutory joint committees, are responsible for implementing the specifications in their commissioning of services, along with assessing compliance against national standards. NHS England has developed Specialised Services Quality Dashboards alongside service specifications, which provide additional data to monitor the quality of services.

Answered by:
Helen Whately (Conservative)
13 May 2024