Blog: Specialised services at a crossroads: working to ensure a sensible approach to change.

By: Alice Fabre, Director, Federation of Specialist Hospitals

As the NHS prepares to delegate the majority of specialised services commisisoning to Integrated Care Boards (ICBs), specialist providers are faced with a radically different approach that comes with a range of opportunities and risks.

Whilst the potential for increased integration across pathways may give patients with rare and complex conditions a more streamlined experience of care, the clarity of national commissioning will be replaced with a far more complex set of arrangements that might differ by service line as well as geography. 

The Getting it Right First Time (GIRFT) Programme has demonstrated time and again that centralisation of complex procedures delivers better outcomes and better value for money for the taxpayer.  It is essential that the new system safeguards this premise and does not lead to the proliferation of sub-scale services.  ICB commissioning does run the risk of local priorities taking precedence over those affecting smaller patient populations and commissioning at the appropriate footprint will help to address this.

Specialist providers play a unique role in the health service and are widely recognised for their clinical excellence within individual specialties. Many are serving as surgical hubs to help address the low volume high complexity elective care backlog. Specialist centres also play a leading role in driving research and innovation. Our members are keen to ensure that their deep understanding of specialised services and the needs of the patients whom they treat, is deployed in the new system, where specialised expertise is likely to be stretched and providers can deliver effective, inclusive leadership.

The Federation of Specialist Hospitals (FSH) is a coalition of some of the country’s best known and regarded hospitals, which provide specialist services to patients drawn from all parts of the UK. We are taking a constructive approach to engaging with policy makers and are determined to ensure that the new architecture is workable and does not destabilise the provision of high-quality specialised services for the patients that need them. 

Members of the Federation are working closely with the NHS England specialised commissioning team via the Future Care Model Programme (FCMP) Specialised Services Reference Group (chaired by Lauren Hughes, NHSE Specialised Commissioning, Director, Strategy, Transformation and Quality) and Financial Engagement Forum (chaired by Jonathan Rowell, Director of Finance, NHSE Specialised Commissioning). Additional ad-hoc engagement across the specialised commissioning team and our broader relationships across the health care system are essential for assessing the impact of the proposed changes and how to respond.

Over the next few months, we will continue to seek to ensure that the voice of specialist providers is heard and look forward to collaborating with colleagues across the health landscape to ensure that patients with rare and complex conditions continue to receive excellent care when they need it.

Specialist hospital members of the National Orthopaedic Alliance are indirect members of the Federation, with their views represented via the Royal National Orthopaedic Hospital.  Enquiries about direct membership for 2022/23 would be welcome via: Alice Fabre, Director, Federation of Specialist Hospitals: