Specialised Services deliver cutting-edge care and are a catalyst for innovation, supporting pioneering clinical practice in the NHS.

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 directly commissioned by NHS England. Three factors determine whether NHS England commissions a service as a prescribed specialised service. These are:

Specialised Services deliver cutting-edge care and are a catalyst for innovation, supporting pioneering clinical practice in the NHS.

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 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.

NHS England has a legal duty to fund certain new medicines and devices recommended by the National Institute for Health and Care Excellence (NICE), but also makes available additional funding each year for other new treatments. The three-stage approach used for making decisions about which new treatments and interventions to routinely commission is described in their service development policy.
Doctors, other healthcare professionals, and patient and public representatives are involved at every stage of this decision-making process.

NHS England have produced key documents to support specialised services
NHS commissioning » Key documents (england.nhs.uk)

From July 2022 the Health and Care Act 2022 legally established 42 Integrated Care Systems (ICSs) –  partnerships of organisations that come together to plan and deliver joined up health and care services to improve the lives of people in their area. Each ICS will have an Integrated Care Board (ICB) – a statutory NHS organisation responsible for developing a plan for meeting the health needs of the population, managing the NHS budget and arranging for the provision of health services in the ICS area. Now that ICBs are legally established, Clinical Commissioning Groups (CCGs) have been abolished. You can find more information on these changes here.

The Act also enables NHS England and NHS Improvement to arrange for its functions to be delegated or jointly delivered with ICBs. In May 2022, NHS England and NHS Improvement sent a letter to ICBs and NHS Trusts outlining the next steps for the delegation of some direct commissioning functions to ICBs. As part of this, they have also published a Roadmap setting out the direction of travel towards more integrated commissioning of specialised services with local commissioners, which the Health and Care Act 2022 will now enable.

NHS England will continue to set national policies and standards and will remain ultimately accountable for the commissioning of all specialised services.

Cases in psychodermatology are often complex. Acknowledging the nationwide lack of psychodermatology resources, Psychodermatology UK have organised a monthly psychodermatology MDT for clinicians to discuss cases and obtain advice for a panel of experts. If you would like to discuss a case please contact Dr Alia Ahmed by clicking here.