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How are they commissioned and managed?

The National Specialist Commissioning Advisory Group (NSCAG) was established to commission services on a national basis for a specific group of extremely rare conditions or very unusual treatments. It was in operation in various guises since 1983 and has now been superseded by the NCG. The NCG advises ministers on which NHS services are best commissioned nationally, rather than locally, to ensure high quality of clinical care and equity of access for patients, as well as securing value for money.

Commissioning arrangements for specialised services were strengthened following an independent review led by Sir David Carter – the NSCG, the NCG and SCGs were established as a result.

Specialised Commissioning Groups (SCGs)

Ten new SCGs have been established to commission services on a regional basis. This succeeds mixed arrangements of region wide and local commissioning groups. Each new SCG acts on behalf of a population of about five million people and services commissioned at this level include haemophilia services, and blood and marrow transplantation. The 10 SCGs are now aligned with the 10 Strategic Health Authorities (SHAs).

The National Commissioning Group (NCG)

The NCG replaces the National Specialist Commissioning Advisory Group and commissions services on a national basis for a specific group of extremely rare conditions or very unusual treatments. The NCG is a standing committee of the NSCG and is supported by the National Commissioning Team, which has transferred from DH to NHS London to undertake the day-to-day commissioning work and national support.

Most services commissioned by the NCG relate to a condition where the national caseload is less than 400 people. Examples include heart and lung transplantation and secure forensic mental health services for adolescents. The total annual budget for the NCG is £346 million. This was previously a central DH budget but from 2007-8 funding has been returned to PCT baselines and transparently levied on a fair shares basis.

Ministers continue to have the final decision on the designation (and de-designation) of nationally commissioned specialised services, based on recommendations from the NCG and NSCG.

Regulations were altered in March 2007 to allow SHAs to commission those specialised services listed on a schedule. An inter-authority agreement between the SHAs sets out delegated responsibility for NHS London to commission and contract for specialised services on behalf of the NHS in England. NHS London is the host employer for the National Commissioning Team. 

• National Specialised Commissioning Group

The National Specialised Commissioning Group (NSCG)  

The NSCG is a completely new advisory body and was established to oversee the national commissioning function and to facilitate collaborative working at a pan-SCG level. The core membership is the chairs of SCGs, usually PCT chief executives.

• National Specialised Commissioning Group

Benefits of specialised commissioning arrangements

The underlying aim of the arrangements for commissioning specialised services is to ensure fair access to clinically effective, first class, standard, specialised services right across the country.

Specialised services are services where patient numbers are small and a critical mass of patients is needed in treatment centres to:

• achieve the best outcomes and maintain clinical competence,
• sustain the training of specialist staff,
• ensure cost-effectiveness in provision,
• make the best use of scarce resources (including staff expertise, high tech equipment, donor organs).

Effective commissioning of specialised services ensures:

• the right patient (clear patient selection criteria and referral guidelines) is offered,
• the right treatment (evidence based, clinically and cost effective interventions) by,
• the right provider (monitored against agreed service/clinical quality standards) in,
• the right place (optimising geographical access but avoiding unnecessary duplication of provision) at,
• the right cost (robust costing and information systems and demonstrable value for money),
• with the full involvement of the patient (adequate information to enable supported choice).