Stevens’ specialised commissioning vision must have clarity

One of the many ironies no doubt now confronting new NHS England chief executive Simon Stevens will be the need to get a grip on specialised commissioning. His predecessor – and master of grip – Sir David Nicholson declared in January 2013 that NHS England would act as “a big, powerful commissioner” to take control of “the commanding heights of the health economy” represented by the large hospitals carrying out most specialist work.

‘Many clinical commissioning groups are still sore over the cash annexed by NHS England’

That ambition has not been realised and Mr Stevens is in the process of strengthening NHS England’s leadership and capacity in that area. The scale of the challenge is further highlighted by HSJ’s analysis of NHS England’s half a billion overspend on specialised services in the last financial year.

• Exclusive: Specialised commissioning overspend tops £450m

The inflated budget for this year’s specialised work requires £800m of cost savings with no previous suggestion the sector has the ability to deliver such a number.

Focus on the details

The implications of the overspend do not rest solely with providers. Many clinical commissioning groups are still sore over the cash annexed by NHS England to support specialised commissioning and are trying to repatriate some of it. However, the pressure on the specialised budget means they could win the argument only for NHS England to pull the lining from its empty pockets with an apologetic shrug.

‘Stevens hopes to present the country and its election-ready politicians with a vision for the NHS which has the broad support of the service’

The widely accepted need to reconfigure specialised services is driven by concern over variability of care. However, Sir David was rightly just as worried about the inefficiency that created, accentuated by differing prices paid for the same work.

This autumn Mr Stevens hopes to present the country and its election-ready politicians with a vision for the NHS which has the broad support of the service. A test of the plan’s robustness will be how much clarity it can bring to the somewhat fuzzy visions for specialised services produced to date – which focus on the big picture, but lack the all important, politically sensitive, where, when and who details. Without those, a catch-22 of overspends and quality variation is set to continue.