Stephen Gilbert MP : NHS’s secretive devolution of healthcare

Steve Gilbert MP for St Austell and Newquay

Steve Gilbert MP for St Austell and Newquay

Stephen Gilbert MP says NHS England is “wrong, rushed and secretive” in plans for specialised health care.

From HIV and cystic fibrosis to multiple sclerosis, muscular dystrophy, epilepsy, haemophilia, leukaemia and renal dialysis – tens of thousands of people across Britain call upon specialised health care services. Far from being niche or peripheral, or of interest only to those with genetic conditions, the treatment of these conditions is relevant to everyone. And they are a large part of the NHS budget, accounting for £14.6billion – over 14% of the total NHS budget in 2015/16.

The Health and Social Care Act 2012 introduced significant and welcome reforms to the commissioning of specialised services. Uniquely this part of that package of reform met with cross-party support as well as enthusiastic endorsement from patient groups. In short, the commissioning of specialised services was centralised at the national level as a direct responsibility of NHS England and over the last year patients have seen a sustained improvement.

Now NHS England want to unpick one of the success stories of the reforms. Since May 2014, NHS England has engaged upon a wholesale internal review of its specialised commissioning function. A major driver of this was a deficit in the specialised budget due to a widely predicted underestimation of what had been spent on specialised services prior to April 2013 and an overspend on the Cancer Drugs Fund. The first of these issues was rectified last December when the deficit was eliminated with an increase in the baseline budget for specialised commissioning for 2015/16 – a welcome development.

What is less welcome are plans now being taken forward by NHS England at the highest levels following the review. In a Board paper from last November, NHS England published its ‘next steps on specialised commissioning’ – to the dismay of patient organisations, some of whom have been involved with specialised services for over a decade and yet none of whom had been contacted or engaged with.

The paper set out several principles for ‘co-commissioning’, devolving specialist healthcare services back down to the local level – in essence a return to the status quo ante the 2012 Act and, arguably, at odds with Parliament’s will.

Asking local commissioners to plan and procure the complex facilities required for rare and complex disorders was unsuccessful in the past and there’s no reason to believe it will succeed in the future. The high cost of these services and the unpredictability of demand for them is financially destabilising to local commissioners and it makes no sense for a local commissioner to retain expertise in so many field when they may have few or no patients requiring them.

Despite the clear views being expressed across the patient community, neither NHS England nor the Department of Health has opened any consultation on these developments. No stakeholder events have been held and NHS England has not even published full and explicit details of its plans for co-commissioning – the plans are wrong, rushed and secretive.

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