Daily Insight: Back to the Spec Com future

NHS England took on responsibility for specialised commissioning in 2013, following a fragmented system run by groups of primary care trusts pre-Lansley.

This latter arrangement commissioned services, set service specifications and decided whether to routinely commission or fund a particular treatment. This created a postcode lottery, with standards and access varying from region to region.

Now NHSE is going back to something not far from that. Its February board meeting agreed to form nine statutory joint committees, bringing NHSE specialised commissioners together with integrated care systems.

This will be an intermediary step in 2023-24, during which the centre will keep control of the finances, liability, contracting, and staff, but it will make decisions jointly with the committees.

The centre hopes to take a backseat from April 2024 and fully delegate commissioning. It is taking a two-step approach because 40 of the 42 ICSs said they were not yet ready for full delegation, and wanted to go with the joint committees first.

It is not entirely a return to the old ways – this time, NHSE will continue setting national service specifications and access standards in a bid to avoid another postcode lottery.

History repeating?

It’s been three years since the harrowing inquest into Harry Richford, who died after a traumatic and botched birth at Queen Elizabeth the Queen Mother Hospital in Thanet. The case led to an independent inquiry and the uncovering of widespread poor care in maternity units at East Kent Hospitals University Foundation Trust.

Yet some of the problems highlighted then seem to still be occurring. An unpublished Care Quality Commission report is expected to be highly critical of elements of care provided by the trust, including monitoring and responding to unborn babies’ heartbeats – a key issue in the Richford case. In addition, the trust is still unable to reach the standards needed for a discount on the maternity clinical negligence scheme and its board papers indicate there have been recent worrying incidents.

No one doubts the difficulties in overcoming entrenched attitudes and behaviours: it is striking that non-executive directors were concerned that many maternity staff seemed not to have read the report of the independent inquiry two months after publication.

But three years after its glaring failures were made public, some of the families involved are beginning to question whether the trust has the capacity to change without greater external support.