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. We also support trials of treatments, such as PrEP (Pre-exposure prophylaxis, a drug to prevent HIV), and an evaluation of mitochondrial donation, a form of IVF in which the future baby’s mitochondrial DNA comes from a donor egg to avoid passing on inherited diseases.

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. Unlike most healthcare, which is planned and arranged locally, specialised services are planned nationally and regionally by NHS England.

In total, there are 149 specialised services currently directly commissioned by NHS England. Three factors determine whether NHS England commissions a service as 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 2022/23 the planned spend for specialised services is £22.9 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 currently directly commissions all specialised services, we have set out in our Roadmap for integrating specialised services how integrated care boards will be given a bigger role in commissioning some specialised services from April 2023.

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 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.


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 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.

For up to the minute latest news please also check out our news section.