Specialised services are those provided in relatively few hospitals, accessed by comparatively small numbers of patients but with catchment populations of usually more than one million. These services tend to be located in specialised hospitals that can recruit a team of staff with the appropriate expertise and enable them to develop their skills.

Transformation work that took place prior to 2016

In recent years we have led on and supported a number of improvement projects and programmes.

• The future of Ealing Hospital’s neonatal special care unit
• North Central & North East London’s Specialised Cancer and Cardiac programme (2013-14): Revolutionising cancer and heart disease for millions

Current transformation programmes (2016 onwards)

We are working closely with providers and the wider health economy in order to ensure that specialised service provision is high quality, sustainable, able to meet future demand and good value for money for the taxpayer. In order to improve specialised service provision, a transformation programme is underway across London. Some of the work will be London wide and some will be led at a more local level.

We are committed to delivering high quality and sustainable specialised services in London, both for our own population and for those that travel here to receive care. To achieve this, together with local leaders, we are considering alternative ways to deliver and plan specialised services.

We will:

• Reduce the number of people requiring specialised services by developing a whole system approach to how services are commissioned and provided, maximising preventative measures both in the community and in hospital;
• Eliminate unwarranted variation in the quality of care, to ensure equity of access, outcomes and experience for all;
• Build on our knowledge of where patients go for treatment and the relationship between services to determine new and innovative ways of commissioning and providing services which improve their quality, safety and cost effectiveness
• Ensure that the integration of physical and mental health is placed at the heart of our specialised service delivery
• Put in place financial controls in ways that provide clear incentives to transform services and integrate specialised care with the whole care pathway.
• Establish financial sustainability: both commissioners and providers will need to be more efficient and productive given the constrained growth in NHS spending over the next two years.

The following service groups have been identified as high priority areas for transformation, following clinically led reviews identifying the most opportunities for improvement:

• Cardiovascular
• Renal
• Specialist Cancer
• Specialist Paediatrics
• Neuro rehabilitation
• Adult secure mental health
• Childrens and Adolescent Mental Health Services (CAMHS)
• HIV
• Transforming Care Partnerships (Learning Disabilities)

When progressing improvement work in these areas we will continuously be keeping abreast of other national and local programmes of work taking place, so we can ensure that all interdependencies are effectively managed. For example, we recognise that there are key relationships between certain non-specialised services and some of the specialised service groups above. Regular discussions are taking place with the appropriate footprints to ensure that any interdependences are effectively managed, whilst also ensuring that communications are as unified and streamlined as possible.

Similarly, since a large proportion of spending on specialised services in London is for patients who travel here from elsewhere within the country to use a range of specialised services, we will also ensure appropriate engagement of stakeholders from outside London.

Clinical service specific ‘working groups’, comprised of clinical specialists, will take a leading role in shaping the plans, and service specific patient representatives will also be actively involved in the formation of plans. NHS England London Region’s Specialised Commissioning Planning Board has oversight of the Transformation Programme and London’s Clinical Senate Council will provide clinical assurance for the programme. In addition to those mentioned above, numerous other organisations will be involved and engaged with this work, including NHS provider organisations, Local Authorities, Healthwatch organisations, third sector organisations, local patient groups and NHS Improvement. Robust stakeholder mapping exercises have been, and will continue to be, undertaken as the programme develops in order to ensure that everyone is appropriately involved and engaged.

Proposals are in the very early stages of development and there is currently no formal engagement underway, however, once plans become more developed then further information around engagement plans and events will be made available here.

For further information about the early work underway please use contact below.

• Pan- London work
• South London programme

Should you have any questions relating to the current transformation work please contact Programme Officer, Jane Ritchie, in the first instance via jane.ritchie1@nhs.net. Jane will ensure that your request is passed to the most suitable individual.