Specialised Commissioning

Specialised Commissioning

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19 February 2024

In December 2023 the NHS England Board approved plans to fully delegate the commissioning of appropriate specialised services to Integrated Care Boards (ICBs) in the East of England, Midlands and the North West regions of England from April 2024. This includes Staffordshire and Stoke-on-Trent.  

These arrangements are part of a careful and considered approach to delegating full commissioning responsibility across England for appropriate services by April 2025.

Moving to ICB-led commissioning supports a focus on population health management across whole pathways of care, improving the quality of services, tackling health inequalities and ensuring best value.

These plans, which were first set out in our Roadmap for Integrating Specialised Services within Integrated Care Systems, have been developed in close collaboration with NHS England’s regional teams, ICBs and specialised service providers.  They follow a thorough assessment of ICB system readiness, and a comprehensive analysis of services to determine their suitability and readiness for more integrated commissioning. 

What is changing – The underpinning principles of delegation

  • The delegation model will enable opportunities for end-to-end pathway transformation to improve population health, reduce health inequalities, and maximise value for money.
  • All services will continue to be prescribed specialised services regardless of whether the are retained for commissioning by NHSE or delegated to ICBs.
  • All prescribed specialised services will continue to need to adhere to national standards, service specifications and clinical access policies.
  • ICBs and NHSE will ensure that all prescribed specialised services meet the needs of local populations (regardless of where they live in England) and that inequalities in access are reduced to create high quality care and outcomes for all.
  • ICBs will build on multi-ICB collaboration and arrangements in 23/24 to ensure the appropriate commissioning footprints for managing delegated services from April 24. While multi-ICB arrangements may evolve over time, the underpinning legal agreement should be future proofed as much as possible.
  • The financial architecture will evolve, with an appropriate pace of change, to support delegated commissioning including moving to a needs-based population budget allocation to help address underlying inequities of distribution.