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NHS England told to set out how specialised care fits within FYFV and deficit by October

Specialised care spending is failing to stay within budget despite receiving more funding than other aspects of the NHS, the Public Accounts Committee (PAC) has said.

The PAC report says that NHS England has not communicated its plan for the future of specialised services to service providers, patients and other stakeholders, or clarified how it fits in with the challenge of delivering the Five Year Forward View and £22bn efficiency savings by 2020.

Specialised services receive more funding than the rest of the NHS, with their budget increasing by 6.3% a year in 2013-16 whilst the NHS budget increased by 3.5% a year. The budget is expected to reach £18.8bn by 2021, or 16% of the total NHS budget. Despite this, the NHS overspent the specialised services budget by £377m in 2013-14 and £214m in 2014-15.

Meg Hillier MP, chair of the PAC, said: “Our committee regularly scrutinises spending and performance within the NHS. Our inquiries and reports over the past year have highlighted significant concerns over planning, weaknesses in data and the risks government efficiency targets pose to desperately needed services.

“As we have reported previously, there is not yet a convincing plan in place to close an efficiency gap running to billions and avoid a ‘black hole’ in NHS finances. Alarm bells therefore ring when we examine an area of the health service that, while benefiting from above average budget increases, is nevertheless failing to keep within spending targets.”

The PAC said the difficulties with specialised spending were partly due to NICE, which does not always consider affordability when approving drugs used by specialised services.

However, decisions to try to make commissioning more effective have sometimes proven controversial – for example, when NHS England and NICE decided to adopt a phased approach to introducing a new hepatitis C treatment, the Hepatitis C Trust filed court proceedings against NHS England.

The PAC said NHS England and NICE should collaborate to ensure affordability is considered when making decisions about specialised spending, including using national bargaining power to get the best prices for drugs.

It also said that NHS England should set out publicly, by October 2016, how specialised services fit within the Five Year Forward View and the deficit, and how it is going to implement collaborative commissioning with CCGs.

The report also found the quality of specialised services varied around the country, from 95% of providers complying with the CQC gold standard in the East Midlands to 74% in the North West.

The PAC warned that NHS England cannot improve its specialised services commissioning because it uses three different payment arrangements, leading to a lack of consistent data on costs, access and outcomes.

Although NHS England said it is improving its data collection processes, the PAC said that by April 2017 it should have clear data on the value for money of specialised services.

NHS England also does not make the minutes of meetings of its specialised services decision-making groups available.

Patient interest groups and pharmaceutical companies raised concerns with the PAC about the lack of transparency in the decision-making process, leading the PAC to recommend that NHS England publishes a statement on the transparency of its decision-making groups by September 2016.

NHE contacted NHS England for a statement but it did not respond at the time of publication.

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