NHS England launches major exercise to shape the future of specialised services

Patients, clinicians and other key stakeholders are being encouraged to give their views on the future of specialised health services, and how they are to be provided by the NHS over the next five years.

NHS England is inviting patients, patient groups, commissioners,  clinicians and others to a special event in December as part of its wider ‘Call to Action’ project, which was launched in July, signalling the start of an open and honest debate with the public about the future delivery of NHS services.

Specialised services are those services which are provided from relatively few specialist centres. Conditions treated range from long-term conditions, such as renal (kidney services), mental health care in secure settings and neonatal services, to rarer conditions such as uncommon cancers, burn care, medical genetics, specialised services for children and cardiac surgery.

They are commissioned nationally through 10 of NHS England’s 27 area teams. They account for around £11.8 billion of annual spending, or around 10 per cent of the overall NHS budget.

Feedback from the December scoping event, which is being delivered in partnership with the Specialised Healthcare Alliance, working alongside other key stakeholders, will inform the development of a five year strategy outlining how specialised services are best provided to improve patient experience and outcomes, against a backdrop of financial challenges and rising demand.

James Palmer, who is Clinical Director for Specialised Services and is leading the development of the strategy, said: “We want to hear from as many people as possible over the coming months about their views on the future direction of specialised services.

“The delivery of specialised services involves the whole health system. NHS England is the direct commissioner for the majority of the services, but Clinical Commissioning Groups and local authorities are also responsible for commissioning parts of the pathway, and delivering, elements of care. Many of the conditions treated in specialised services are highly debilitating, life-long and demand the advice of experts, as well as responsive access to care locally when needed.

“The feedback received from stakeholders will help to inform a five-year plan which will drive forward the promotion of equity and excellence in the commissioning of specialised services, and ensure that patients receive high quality, integrated care, regardless of where they live”.

John Murray, Director of the Specialised Healthcare Alliance, a coalition of more than 90 patient organisations, said: “It is vitally important that patients, patient groups, clinicians and others have a sense of ownership of the five year strategy for specialised services. We will use the scoping event in December as a starting point, but there will be lots of other opportunities for people to contribute their thoughts as the strategy develops”.

The scoping event will be held in London on 9 December. Anybody who is interested in being involved in the debate about the future of specialised services and wishes to apply for a place should email

Places at this event will be limited. However, all those who wish to contribute their views, but cannot attend on the 9th, or fail to secure a place, will have opportunity to provide a written submission. Details of how you can do this will be published on the NHS England and Specialised Healthcare Alliance websites shortly.

Specialised Healthcare Alliance


  1. Saskhia Menendez says:

    Equality is key and fairness to transgender users is essential no point in making broken promises and bringing out a protocol that neither works or has any framework I have infact suffered at the hands of the nhs as each department or ccg ect I used or turned to for help made up there own rule waiting times are ridiculous and false promises where made such as laser treatment for which no invoicing policies or framework have still be put in place one year later and I’m sick or being treated like a second class citizen when I was born here

  2. Molly Barrett says:

    I quote from above: “Places at this event will be limited. However, all those who wish to contribute their views, but cannot attend on the 9th, or fail to secure a place, will have opportunity to provide a written submission. Details of how you can do this will be published on the NHS England and Specialised Healthcare Alliance websites shortly.”

    Please define “shortly” and please provide a link to the location of the opportunity.

    Thank you, but without much hope, judging by the lack of response to previous questions left by others.

  3. Julia A Flack (nee Lane) says:

    The reason you are all in deficit is due to the following problems:-

    a) Under staffed Trained Doctors and Nurses.
    b) Too many doctors and appointments cross referencing patients information.
    c) Lack of funding as the social care systems have changed.
    d) Need a larger government pot of spending money for England & Wales.
    e) If Scotland want to go alone then they contribute to their own funding.
    f) Alot of trained Doctors/Nurses etc going abroad to help with less fortunate countries.
    g) The government is not giving this service enough incentive for skilled workers to remain in Great Britain.
    h) Not enough support for Carers and their respective families.
    i) Government cannot put this think tank on hold for 6 months as things will only continually get worse.

    Yours faithfully

    Patient at Mulberry 2
    Julia Flack
    CLA Partner

  4. David Sincair says:

    Would neurology, MS MND and Parkinson’s be included?

  5. Alison Grant says:

    Could you please provide details on how I ca n submit a written proposal for specialized services.
    As it is now over a month since the event I thought details on how to do this would have been published.
    Kindest regards

  6. Rebecca Porch says:

    Further to the event in London on 9th December about the future of specialised services, can you please provide details of how to submit a written submission? I know the article said this will be available shortly but if you could please provide the link it would be appreciated.


  7. Laura Turton - Head of Services, Hearing Link says:

    From 2010 we were commissioned as a charity to provide our Intensive Rehabilitation Programmes to all patients who are diagnosed with Neurofibromatosis type 2 (NF2).

    These programmes are a dedicated programme for adults with a diagnosis of Neurofibromatosis Type 2 and their families. The programme focusses on profound hearing loss associated with NF2, and aims to support people to manage hearing loss through information, social and emotional support, communication strategies and technological solutions. A central focus of this 5 day programme is the effective facilitation of peer and ongoing support.

    Up to this commissioning point 1-2 patients per year applied to their PCTs for individual funding, often waiting months for a confirmation, with a 30% success rate. Since the commissioning we have supported on average 18 patients a year with a strong evidence base for showing short and long term outcomes on quality of life and improving the psychosocial effects of hearing loss (measured up to 12 months).

    It should be noted that patients with NF2 are the only aetiology who have this direct access to these programmes.

  8. Ian Davis says:

    I think it important that NHS services continue to be provided in local easily travelled to locations. This means we must maintain or even increase the local hospitals and clinics which can provide accommodation for these out patient appointments.
    Also some local beds need providing for rehabilitation and recovery (also end of life care) outside the large specialist hospitals.

    My experience is that there is a tendency for local services to be shut down for short term savings. This is does not help the older or poorer of our society.

  9. Mr&mrs n Thompson says:

    All services wherever possible should be available in patients local areas Large centralised centres are not a sensible option. Too much of NHS money is wasted on administration costs and excessive salaries

  10. Paul Thorpe says:

    Thank you for requesting responses.
    In summary, it is extremely important that the commissioning process supports the provision of high quality services that demonstrate good patient outcome, rather than a simple drive to centralise services in ‘big centres’.

    There are, of course, elements of medical care that need to be highly centralised – for example, treatment of Congenital Scoliosis, and Primary Malignant Spinal Tumours might usefully be centralised in no more than 4 or 5 centres in NHS England. However, this is a very small part of the general practice of spine surgery, and there is no evidence that commissioning of all Spinal MSCC or Adolescent/Degenerative Scoliosis services should follow that pattern, as the large centres currently, and will for the foreseeable future (especially in the SW of England), lack capacity to absorb all the work currently performed by other centres.

    The spinal community has voiced this through our replies to the CCG Specialist commissioning process, which defined several levels of expertise in spinal surgery.

    It was extremely disappointing, therefore, to see the recent NHS England document ‘approving’ uplifts for specialist spinal surgery, had completely failed to recognise the levels of specialist surgery provided in the units in Gloucester, Taunton and Exeter in the South West, and allocated uplifts for Salisbury that does not perform specialist deformity surgery. This needs to be corrected.

    The South West of England has been moving towards more co-operative networks in spinal surgical practice – Taunton and Exeter now provide a joint on call system covering Somerset, Devon and parts of Dorset and Cornwall, and we now have an established link with Bristol where we refer our very complicated occasional patients, go up to operate on them as joint cases, and then perform their post op follow up in the referring centre. This means that the vast majority of cases are given timely treatment, in a more local centre, with good outcome, and those complex cases that do need the support of such services as PICU are treated appropriately.

    It is very important that the commissioning process supports this type of service and network, by supporting appropriate services to be maintained in DGH units, rather than driving pure centralisation for centralisation’ sake, by definitively denying access to appropriate tariffs to certain units. This approach in the past has been shown to lead to poor service for patients, as overcentralisation leads to poor compliance with access targets and delay in appropriate clinical treatment for patients. Unfortunately, those wishing to ‘build empires’ seem to enjoy a long waiting list, as it demonstrates how busy and important they are. Unfortunately, it is not very good for patients to foster this approach. NHS England has great challenges ahead on delivering high quality specialist and sub specialist services to patients – and it needs to support those areas of good practice in DGHs that exist already.

    Paul Thorpe
    CSL Somerset Spinal Surgery Service

  11. Ben Peyton-Jones says:

    Typical that short notice is given to clinicians who need to give 8 weeks notice to take a day off to attend such an event. And then you blame us!