Specialised services

What are specialised services?

Specialised services support people with a range of rare and complex conditions. They often involve treatments provided to patients with rare cancers, genetic disorders or complex medical or surgical conditions. They deliver cutting-edge care and are a catalyst for innovation, supporting pioneering clinical practice in the NHS. For a quick overview of specialised services watch our animation.

These services include a range of treatments, from interventions that most of us have heard of, such as chemotherapy, radiotherapy and kidney dialysis, through to pioneering procedures that are currently only carried out in small numbers, such as using a patient’s own tooth to restore their sight, and hand transplants.

Specialised services are not available in every local hospital because they have to be delivered by specialist teams of doctors, nurses and other health professionals who have the necessary skills and experience.

In total, there are 150 specialised services. Three factors determine whether a service is a prescribed specialised service. These are:

  • the number of individuals who require the service
  • the cost of providing the service or facility
  • the number of people able to provide the service or facility

In 2023/24 the spend for specialised services was £25 billion. The level of funding for these services has risen more rapidly compared to other parts of the NHS, but it is still under pressure. The number of patients needing specialised services is rising due to an ageing population and advances in medical technology.

Although NHS England has historically directly commissioned all specialised services, integrated care boards are increasingly now taking on a bigger role in commissioning some specialised services.

Making decisions about new treatments

We have a legal duty to fund certain new medicines and devices recommended by the National Institute for Health and Care Excellence (NICE), but where possible, we also make available additional funding each year for other new treatments.  For these new treatments, we have to make complex decisions about which represent the best value for patients and taxpayers. We have a duty to ensure that new treatments are supported by convincing evidence of safety and effectiveness, that they are affordable and offer value for money, and that decisions about them are fair and transparent. Doctors, other healthcare professionals, and patient and public representatives are involved at every stage of this decision-making process.

Prioritisation

For proposed new treatments which require additional investment, NHS England carries out a relative prioritisation process to determine which services will be routinely commissioned. The video below explains how all the proposed new treatments are independently assessed by the Clinical Priorities Advisory Group (CPAG) on their likely relative clinical benefit and relative cost.

CPAG then makes its recommendations to NHS England who review these recommendations against the budget available and considers which new treatments, if any,  to recommend for funding.

For more information on how we make decisions see our infographic. Our service development policy sets out how this works in more detail.

Prioritisation decisions

A summary of the outcome of the most recent relative prioritisation round can be found here:

Contact us

For any general enquiries about specialised commissioning, please email the specialised commissioning team (please do not send urgent correspondence to this address).

If your query relates to a Clinical Reference Group, please email england.voice-crg@nhs.net.

Latest news and updates

If you would like to keep up to date with the latest news and developments in specialised commissioning then you can register as a stakeholder.