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Developing a five-year strategy will address some hard truths – James Palmer

By James Palmer, NHS England’s Clinical Director for Specialised Services:

Part of the future success of health care, integrated across hospitals, general practice and into the community, is dependent on how NHS England approaches its direct commissioning responsibility for specialised services. If a patient needs a heart bypass operation; a kidney transplant; a brain tumour removed, or if a child needs the support of intensive care to survive, our expectation is that of prompt access to care, delivered by services of the highest quality.

As we plan our five-year strategy for specialised services, we know there are some hard truths to address. Specialised services account for £12.2 billion per annum of the NHS allocation. Historically, the growth in cost exceeds other parts of healthcare by as much as 4% per annum, and we already on the back foot with our costs exceeding the available finance.

In our first year of operation, NHS England has established the building blocks of direct commissioning. All 143 prescribed specialised services have a national service specification against which providers are contracted, processes are in place to establish clinical policies, and there are developing strategies for measuring service quality. In addition, we have developed a new scheme, Commissioning through Evaluation, to introduce new technologies in a systematic way.

The next couple of months will see a significant increase in our work with Area Teams, CCGs and other stakeholders as we move towards production of a draft strategy. In the meantime, please have a look at our new specialised commissioning web pages.  We are constantly trying to improve the information we publish about specialised services, and have created a new web space in which we hope to bring together everything you need to know about this area of healthcare. If we are missing anything, please let us know by emailing us at england.contactus@nhs.net, or you can Tweet using the hashtag #speccomm

We held a successful event in London on 9 December as part of initial work to develop the stakeholder view of what might be included in the five-year strategy for specialised services.

Around 100 stakeholders attended on the day, including patients, providers, clinicians, commissioners, and representatives from patient organisations and industry. Feedback collected from the event, as well as from written submissions, has been used to produce a report which NHS England is publishing today.

We now build on this at further events where we can hear the views of the stakeholders associated with area teams and start to establish what are the strategic priorities.  View details of the area team events

Earlier this week, NHS England launched an innovative phase of its specialised services strategy development with an invitation for submission of service level change proposals.  Our Clinical Reference Groups, Clinical Commissioning Groups, providers, patient groups, and industry partners, are all encouraged to support the strategy development by offering succinct and realistic proposals for change.

We are inviting submissions from anybody with an interest in specialised services and have produced a simple guide to support you in making a proposal. Submissions can be created using the online web tool or you can download a sample template from our website. Full details of how to do this are on the website.

There will be lots happening during the coming months so please do look out for my blog for updates, and make sure you visit the specialised commissioning pages for all of the latest news.

Finally, I would like to take this opportunity to thank all stakeholders – both individuals and organisations – who are contributing to the Call to Action for specialised services. Your efforts have been invaluable. Special thanks go to the Specialised Healthcare Alliance and Rare Diseases UK, for their significant efforts in supporting us in delivering the best possible levels of engagement as we develop our future.


James PalmerJames Palmer qualified in Medicine at The London Hospital Medical College in 1985, and trained in neurosurgery in Southampton and Glasgow.

He moved to Plymouth from a clinical academic position at the National Hospital for Neurology and Neurosurgery, Queen Square in 1999. He led a transformation in the Peninsula neuroscience services including the establishment of the South West Stereotactic Radiosurgery Service.

In January 2005, James became Assistant Medical Director (Operations) at Plymouth Hospitals NHS Trust and onwards to Joint Medical Director.

He moved from provider medical leadership to commissioning in 2009 as Medical Director South West Specialised Commissioning Group.

After working as clinical lead in the transition period in April 2013 James was appointed Clinical Director Specialised Services in the Medical Directorate within NHS England.

He has developed a broad clinical leadership model with the NHS England national Clinical Reference Groups and leads the strategic planning of the direct commissioning of specialised services while continuing his role as Consultant Neurosurgeon at Plymouth Hospitals NHS Trust.

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