PARLIAMENTARY WRITTEN QUESTION
Health Services (9 May 2024)

The nine joint committee arrangements arose from a robust process, which included a readiness assessment, the Pre-Delegation Assessment Framework, made between integrated care boards (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. NHS England is working 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.

On 28 March 2024, the NHS England Board approved the recommendation that the 32 specialised services listed in Annex A of Item 7 of Specialised Commissioning: update on specialised services for delegation, would be retained by NHS England.

Regardless of delegation status, NHS England will remain the accountable commissioner for the entire portfolio of specialised services, and as part of this role, will monitor the effectiveness of delegation and the lists of services. It should be noted that NHS England does have the ability to bring a service back under national commissioning control, under the safeguards put in place to support delegation.

All specialised services, whether retained or delegated, must comply with nationally developed standards, including service specifications and clinical commissioning polices. ICBs will be able to use specialised services funding to transform and develop services and pathways across their core and specialised responsibilities, to improve quality of care and equity of access and value, whilst also complying with national standards.

Whilst delegation is not an end in itself, moving to ICB-led commissioning supports a focus on population health management across whole pathways of care, and gives ICBs the powers they need to improve the quality of services, tackle health inequalities, and ensure best value. NHS England set out in detail the benefits of greater ICB involvement in the commissioning of appropriate specialised services in the Roadmap for Integrating Specialised Services within Integrated Care Systems, and subsequent board papers. This roadmap is available at the following link:

https://www.england.nhs.uk/wp-content/uploads/2022/05/PAR1440-specialised-commissioning-roadmap-addendum-may-2022.pdf

These plans have been developed in close collaboration with NHS England’s regional teams, ICBs, specialised service providers, clinicians, and patients, and represent the outcome of a thorough assessment of ICB system readiness, and a comprehensive analysis of services to determine their suitability and readiness for more integrated commissioning. During 2024/25, specialised services commissioning teams will remain employed by NHS England. NHS England has a framework for commissioning support, and accesses a range of services from commissioning support units. For example, data and business intelligence, and programme and project management expertise and resources.