NHS England and NHS Improvement publish roadmap for delegation of specialised services


NHS England and NHS Improvement (NHSE/I) have set out their plans to delegate responsibility for a range of services to an ‘Integrated Care System’ (ICS) level. This means that many services that are currently planned and commissioned at a national level (i.e. specialised) will now be planned and commissioned at a regional level. The ‘Roadmap for integrating specialised services within Integrated Care Systems‘ is part of broader NHSE/I reform that will fundamentally change how many services for people affected by neurological conditions are commissioned.

Key neuroscience services to be delegated

NHSE/I states that the Roadmap charts a ‘phased and managed approach’ to integrating commissioning of specialised services with wider Integrated Care Board (ICB) responsibilities, expected to take hold in April 2023.

Key services earmarked for ICS leadership include:

  • Adult neurology
  • Adult neurophysiology
  • Adult rare brain and central nervous cancers
  • Neuropsychiatry, both children and adult
  • Paediatric neuroscience
  • Paediatric neurorehabilitation
  • Neurosurgery
  • Neuroradiology
  • Complex rehabilitation for ‘patients with highly complex needs’ (likely to include neurorehabilitation for adults)

Low volume neurosurgery procedures, transcranial magnetic resonance guided focused ultrasound, adult ataxia telangiectasia services, diagnostic services for rare neuromuscular disorders, neurofibromatosis services, hyperbaric oxygen and services for neuromyelitis optica, are not deemed suitable for ICS leadership.

Importantly, NHSE/I retains accountability for the entire portfolio of specialised services, no matter where responsibility for commissioning lies. In addition, all specialised services will continue to be subject to national service specifications and clinical policies. These are likely to continue to be developed with the advice of appropriate ‘Clinical Reference Groups’ (CRGs) within specialised commissioning. Our Chief Executive, Georgina Carr, is currently patient and public voice representative for the neuroscience CRG.

These policies will outline what key service components should include. However, with greater responsibility for provision, ICBs will have flexibility to determine how services are delivered.

The Roadmap follows the creation of new clinical leadership posts, including for National Clinical Directors (NCDs) for neurology and neurosurgery and spinal surgery. These roles will have a key function in engaging with ICS bodies, as delegation of responsibility begins.

Questions remain

The Roadmap does not provide information on where a number of services will ‘sit’ in the new structure, namely neuropsychology. In addition, we are seeking greater clarity from NHSE/I on the proposed definition of ‘rare neuromuscular disorders’.

The NHSE/I neuroscience transformation programme , which will set out future commissioning models for neurology and neurosurgery in greater detail, is still in progress and will feed into revised service specifications for neuroscience. A number of key service specifications have been in development for years, including the neuropsychiatry service specification and neuroscience service specification. It is now absolutely imperative these are finalised ahead of commissioning responsibilities being delegated. The neuroscience transformation programme also must continue at pace, with NCDs swiftly appointed to support it’s progress.

Georgina Carr, Chief Executive of The Neurological Alliance said:

“As a community, we have worked hard to ensure we have the right resources in place to engage with commissioners at ICS level, including new evidence on access and experience of services through ‘My Neuro Survey’. Despite this, we remain concerned that greater delegation could increase unwarranted geographical variation in access to key services.

“We now need urgent answers to our remaining questions as to where commissioning responsibilities for the full range of services for people affected by neurological conditions will sit in the future. Moving forward, we must work as a community to ensure we are able to engage with ICBs and other ICS level representatives in a timely and efficient way, so that the experiences of people affected by neurological conditions are central to how NHS and care services are funded.”

Next steps

The Alliance has already highlighted a number of key questions about the Roadmap to NHSE/I.

We will be convening a working group of our members to establish an effective ICS engagement strategy. This will include utilising ICS level results of ‘My Neuro Survey’. The national results are due to be published on Wednesday 8 June.

Delegation of services is expected to take place from April 2023. New clinical leaders, including NCDs for neurology, neurosurgery and spinal surgery, should be in place by October 2022.

The full Roadmap and accompanying documents are available here.