Steve Sylvester, Head of Specialised Commissioning, Bristol, North Somerset, Somerset and South Gloucestershire Area Team, issues a call to action for help in developing future strategy:
Some say that providing a service in fewer hospitals reduces patient choice and competition. Others are concerned that having to travel further than their local hospital for specialised care isn’t worth the health benefits of being treated at a specialised centre of excellence.
Across England, NHS ‘specialised’ health services cost about £12 billion a year, which is approximately 10 per cent of the total NHS budget. However, they are not the ones that most people think of when they think about what happens in their local hospital. ‘Specialised’ services generally involve complex procedures that only a few people have the skills and experience to perform or services that use specialised, expensive equipment that the NHS simply could not afford to put into every local hospital.
Very often the people who need these services are relatively few in numbers, such as very premature babies or people with rare cancers or genetic conditions.
Currently there are around 130 specialised services, but the list is regularly reviewed against specific criteria to ensure they are still relevant. Some will be removed as the price of delivering a service reduces or the number of people needing a service rises enough to enable the service to be safely delivered from a larger number of hospitals. Similarly, as new innovations and techniques become available these may get added.
Before April, NHS commissioning looked very different. Commissioning policies and service specifications varied across England. This meant people received different care depending on where people lived.
Since it took over responsibility for commissioning specialised services in April, the ambition of NHS England is to bring equity and excellence to the provision of specialised care and treatment no matter where a person lives.
To achieve this clinical experts, patients carers and members of the public have all worked together to develop a single set of national service specifications and commissioning policies for specialised services for the whole of England. NHS England’s specialised commissioning teams are now working to ensure the services in their areas comply with these.
However, we are trying to achieve this at a time when the NHS must find new ways of delivering care that will make more than £20 billion of savings over the next few years. Without such change, the NHS will become financially unsustainable and the safety and quality of services may suffer.
If specialised services need to be in large centres of excellence to ensure service quality, patient safety and the best clinical outcomes, then we need to think differently. Could we join the services of two hospitals that are currently only able to deliver part of a service or failing to treat the desired number of patients to deliver a bigger, better, safer and more sustainable service that is co-ordinated between each hospital? Could teams from centres of excellence come out to local hospitals to deliver part of a person’s care there instead? Can we use research evidence to tell us exactly what procedures lead to better clinical outcomes if they are performed in specialised centres? Are there aspects of care that could safely be delivered elsewhere so that people always receive the right treatment in the right place at the right time and only have to travel to a specialist centre when the evidence suggest this is the best thing for patients?
As part of the Call to Action debate about the future shape of the NHS, NHS England has invited individuals and organisations to help inform the development of its five year strategy for specialised services. We need to involve as many people as possible in helping us to develop the service specific strategy changes. There has never been a better time to have a say on how the NHS can change in order to provide services in the way that you or those close to you would like to access them and receive care.
You are also welcome to contribute your questions and views before the discussion using the hashtag #swspeccomm
Or email your comments to Dr Lou Farbus, Head of Stakeholder Engagement (Specialised Commissioning for the South West): email@example.com
Steve Sylvester is Head of Specialised Commissioning (NHS England: Bristol, North Somerset, Somerset and South Gloucestershire Area Team).
As the head of NHS England’s specialised commissioning team for the South West Steve is responsible for ensuring all specialised services across the region are of the highest quality no matter where people receive their care, and that people will have rapid access to these specialist services when they need them. However, the team aims to ensure people only spend as much time at a specialised centre as is necessary by linking well with local services to support as much care being provided as close to home as possible.
The team also hopes to prevent people from needing specialised care by working with a variety of partners to promote healthy lifestyle choices and support people with long term conditions to manage these in ways that reduce avoidable hospital admissions. In this way Steve and his team aim to commission the right kind of care at the right time to give people the best chance of great care and good outcomes.
Steve has a wealth of NHS experience, starting as a volunteer substance misuse support worker in 1993 and a six year career supporting the rehabilitation of people with a range of addictions as part of the community mental health team.
Between 2000 and 2003 he worked in a local district hospital supporting service improvement through service redesign, clinical audit, waiting list management and patient access. After this he spent six years leading on contracting and commissioning for a local Primary Care Trust until he joined the South West’s previous Specialised Commissioning Team as an Associate Director of Commissioning in 2009 where he supported and guided the team through the NHS’ transition until NHS England came into effect in April 2013.
During this transition period Steve represented the South West on several of the national Clinical Reference Groups that were tasked with developing the national services specifications and commissioning policies that are currently being implemented across England and continues to support NHS England’s development and success. However, he is keen to ensure that decisions taken by specialised commissioners in the South West reflect the needs and wishes of local people, with ‘collaboration and communication’ words that not only reflect what the team does, but how it does it.