Next steps with the delegation of commissioning for specialised services to integrated care boards

NHS England is the accountable commissioner for a portfolio of about 150 specialised services (including highly specialised). In February 2023, it was decided to gradually delegate commissioning for certain services (considered suitable and ready) from NHS England to local commissioners – integrated care boards (ICBs). 

NHS England also defined the lists of specialised services which are suitable but not yet ready for delegation and which are not suitable for delegation (e.g., all highly specialised services). However, regardless of delegation status, NHS England will remain the accountable commissioner for the entire portfolio of specialised services, defining consistent national standards, service specifications, and clinical commissioning policies.

As a first step, since April 2023, 59 services considered suitable and ready for greater ICB leadership have been commissioned by nine statutory Joint Committees of ICBs and NHS England Regions. 

On December 7, 2023, NHS England confirmed the next steps in delegating commissioning responsibilities from April 2024, including the following:

• Full delegation of suitable services to ICBs in the East of England, Midlands, and the North West region;
• One more year of statutory joint commissioning by NHS England and ICBs in the South West, South East, London, and the North East and Yorkshire regions;

By April 2025, there must only be two lists – delegated services and retained services. Therefore, work is underway to review the services that were deemed suitable but, for various reasons, not yet ready for delegation to determine whether, by April 2025, they will be reclassified for delegation or retained. 

To ensure the safe implementation of the planned commissioning reforms, the Future Commissioning Model Programme for Specialised Services was established. The program is focused on ensuring that expert commissioning capacity and capability for specialised services is retained within the system, the new financial architecture and financial flows do not lead to any loss of financial control, and that there are no sudden and de-stabilizing impacts on providers, the necessary data and business intelligence requirements to support effective commissioning are in place, and there are robust oversight and assurance mechanisms for delegated services.

See more information here.

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