Our service has been offering assistive technology services from Barnsley Hospital since 1988, however to date we have not been able to offer our services further afield than Barnsley, Rotherham and Doncaster (despite many attempts) essentially because the commissioning of these services has not been nationally co-ordinated, specified or mandated.
Changes to NHS commissioning were initiated in 2011 with the ‘Liberating the NHS’ white paper which led to the Health and Social Care Act 2012. This act assigned responsibility for commissioning of specialised services to NHS England. NHS England was formed on 1st April 2013.
A process was carried out to evaluate each type of service that was to be commissioned as a specialised service. This process checked, among other things, that the services were ‘low incidence and high cost’. All the services that were previously defined under the ‘Specialised Services National Definitions Set 5’ were agreed to be included as ‘Prescribed Specialised Services’ .
To be able to commission each service NHS England required a service specification –setting out who the services were for and what the services should do. For specialised AAC and EC services, this was the first time a service specification had been written and the first time for specialised AAC services that there had been a national remit to commission services (EC services were originally nationally administered so arguably had been previously nationally commissioned).
These services were clustered as ‘Complex Disability Equipment’ services (CDE). CDE services are again clustered under the Trauma ‘Programme of Care’. Clinical Reference Groups (CRG) for each cluster of services were set up. These groups, which should include patient representatives, are responsible for advising NHS England on all aspects of commissioning of these services, including the service specification. The CRGs also have ‘sub groups’ for EC and AAC services. Our team is represented on these sub groups and Mark Hawley, our Head of Service and Professor of Health Services Research at the University of Sheffield is the Yorkshire and Humber CDE CRG representative.
Having created a service specification, NHS England attempted to understand current provision for all the specialised services it had responsibility for and to move contracts over. In doing this, NHS England identified great variation and disparity in provision of specialised EC and AAC services – these services were unique in this. NHS England thus identified that to provide these services it needed to identify additional ‘convergence’ funding allocation to cover future commissioning of these services nationally. This allocation was to ‘top up’ any existing service provision. This allocation was agreed and signed off by NHS England in September 2014.
NHS England has then carried out a process of contracting with identified service providers. These contracts will allow service providers to start the process of expanding their provision and ‘converging’. NHS England works through ‘Area Teams’, 10 of which currently have responsibility for commissioning services across 10 regions of England.
The contracting work between NHS England and Barnsley Hospital took place in December 2014 and our team achieved a contract variation to begin the process of service expansion from 1st Jan 2015.
These changes have built on a great deal of campaigning and research work, much of it championed by communication matters and the office of the communication champion. Our team was also involved in this particularly in gathering research and other evidence (see the CM-RM project report and DFE Project Report ). We will attempt to document the history of this work at a later date!