24.05.16
NHS England must improve accountability over specialised services, says Lord Warner
There should be “clear-cut, annual accountability” to Parliament and the public for the large sum of public money spent on specialised services, covering past performance and future priorities, the Specialised Services Commission has stated.
In the commission’s final report, led by Lord Warner, a former minister for NHS Reform under the Blair government, it was stated that the geographically dispersed nature of specialised care and the isolation frequently felt by people with rare diseases makes clear lines of accountability for patients and the public all the more important.
Similarly, the high cost of specialised services, which account for almost £15bn of NHS spending, makes it important to ensure that associated public money is well spent. However, a recent National Audit Office (NAO) warned that specialised services spending is out of control and poses a threat to the financial stability of the NHS.
Lord Warner said: “The commission considers that more could be done to improve the accountability, in practice and perception, of NHS England for its decisions as the sole commissioner of specialised services.
“Moreover, across the system as a whole, mechanisms for holding providers and others to account for the quality of specialised services could be enhanced.”
The commission has also recommended that the future approach to the management of specialised services should be founded on the principles of national standards, locally delivered. It added that national standards, set by NHS England, should be retained and developed as the basis for a more innovative approach to the management and delivery of specialised care.
In response, Dr Jonathan Fielden, NHS England’s director of specialised commissioning, said: “Like many aspects of the wider NHS, specialised commissioning has made considerable progress despite the funding challenges: in the last three years we have defined and improved national standards for specialised care, enhanced clinical, patient and public involvement and, in the last year balanced the specialised commissioning budget.
“In the weeks and months ahead we will show how specialised services are strategically aligned to the Five Year Forward View and how, working even more closely with local colleagues in health and other organisations, we will deliver world leading innovative care whilst ensuring best value for patients and the wider NHS.”
Lord Warner recommended to NHS England, providers and the new regulator NHS Improvement that the relationship between commissioners and providers should shift towards networks of providers being given responsibility to deliver an end-to-end service for patients.
He also said that reimbursement models should be amended to reflect and encourage the development of specialised care networks, moving towards annual targeted funding for specific long-term conditions, linked more closely to outcomes. And all this should be underpinned by comprehensive cost and key outcomes performance.
Chris Hopson, CEO of NHS Providers and a commission member, said: “Each year frontline providers of specialised services are facing increasing demands for their services and increasing costs of introducing new NICE-approved medicines and devices. Without a new approach to commissioning and paying for these services, the financial and operational pressures on NHS providers will simply not be sustainable.
“That is why this report from the Specialised Services Commission is particularly timely and helpful, following the recent National Audit Office report that highlighted the lack of a national strategy for specialised commissioning. We strongly welcome this new report’s recommendations on working towards a deeper understanding on the costs of delivery services, tackling the broken payment model for specialised services that has seen financial risk passed from commissioners to providers, and developing a national strategy that takes better account of which services should be designed and commissioned nationally, regionally in networks, and locally in communities.”
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