NHS England has commissioned specialised services since its inception in 2013. There are 154 different specialised services which are generally accessed by comparatively small numbers of patients serving catchment populations of usually more than one million. These services tend to be located in larger hospital trusts that can recruit a team of staff with the appropriate expertise and enable them to develop their skills.
The NHS is making changes to how some specialised health services are planned and delivered. Plans to delegate suitable specialised services were first set out in the May 2022 Roadmap for Integrating Specialised Services within Integrated Care Systems and enabled by the legislative provisions in the Health and Social Care Act 2022. In December 2024, the NHS England Board reaffirmed plans to delegate commissioning responsibility for 70 specialised services to the six ICBs in the South East of England from 01 April, 2025, to the value of £2.3bn.
All ICBs have signed a ‘Delegation Agreement’ which sets out the formal and legal transfer of commissioning responsibility. NHSE will remain the accountable commissioner for the delegated specialised services.
NHS England will therefore, continue to set consistent national standards, services specifications and clinical commissioning policies; develop metrics and quality dashboards to support improvement, oversight and assurance; and, provide national clinical leadership, expert advice and support to ICBs through its Clinical Reference Group infrastructure.
What does this mean for patients?
Delegation of 70 specialised services aims to improve patient care, reduce waiting times, and ensure people in South East England get the best possible treatment when they need. For example it will
enable the planning, commissioning and provision of better and more integrated services for patients across whole and linked pathways of care;
support key aims of the government’s forthcoming ten-year plan to bring about a shift from sickness to prevention; and from hospital to community;
enable ICBs to act as strategic commissioners of specialised services, with providers increasingly reaching into neighbourhood health and care systems.
NHS Frimley’s role in the commissioning of specialised services
The strategic commissioning of specialised services will bring opportunities for NHS Frimley from 01 April, 2025. Through delegation and ICBs taking on new commissioning responsibilities, we have a significant opportunity for a renewed focus on the ‘left shift’ agenda, enabling access to care closer to home as well as integrating specialised and non-specialised pathways improve the health and well-being of patients across the South East.
A new, statutory joint committee arrangement is being established so that our ICB, along with the other five ICBs in the South East, can effectively work together to discharge our new specialised commissioning responsibilities. The scope of this multi-ICB joint committee will be wider than Specialised Commissioning, and will include other areas of joint working important to all ICBs and provide a formal link back to our own ICB Executive Board, which has a statutory responsibility for our local population. Reporting to this, a Specialised Commissioning Sub Committee will ensure that decisions are made collectively across the six SE ICBs, rather than taken independently. This reflects the interdependencies of patient flows across SE ICBs - as there is not a single specialised commissioned service where patient flows are contained to the boundary of a single South East ICB.
Together, this joint committee will agree the clinical priorities where we can jointly make the biggest difference to our patient population. For more information on the governance, please visit NHS Frimley ICB.
In light of the recent announcement to integrate NHS England into the Department of Health and Social Care, we are working through the long-term future arrangements for the 84 specialised and highly specialised retained services, which are not being delegated at this time.
For more information on the delegation of specialised commissioning please visit NHS England » Specialised Commissioning – update on specialised services for delegation
The role of Frimley ICB
Along with being one of the six South East ICBs responsible for commissioning delegated specialised services, Frimley ICB is also taking the role of ‘host’ employer to ensure the safe and effective transfer of employment of staff from NHS England South East region currently working on delegated specialised services.
Staff identified for transfer will TUPE to Frimley ICB (the future host of the multi-ICB specialised commissioning team) on 01 July, 2025.
