NHS Specialised Services

Our History

Arrangements for commissioning specialised services were formalised in April 2007 following a review led by Sir David Carter. The Carter Review made 32 recommendations, including the establishment of the National Specialised Commissioning Group (NSCG), the National Commissioning Group (NCG) and 10 Specialised Commissioning Groups (SCGs).

Until September 2010, key decisions about national commissioning (including agreement of the annual budget and which services should be included within the national commissioning portfolio) were taken through a complex series of steps:

1. The NCG (which had a clinical focus), made recommendations about the budget and about which services should be nationally commissioned to the NSCG (which had a commissioning and financial focus).
2. Any decisions taken by the NSCG then had to be endorsed by Strategic Health Authorities (the 10 NHS bodies that currently manage their local NHS bodies on behalf of the Secretary of State).
3. Ministers then took the final decision on which services should be nationally commissioned and on which centres should provide them.

These complex governance arrangements led to a situation whereby decisions were not always transparent and the recommendations made to Ministers were not always consistent, particularly in the case of high cost technologies.

So the Department of Health consulted on proposals that aimed to strengthen these existing arrangements for national commissioning in England and to adapt the scope of the national commissioning system to consider a very small number of highly specialised technologies.

The outcome of the consultation Strengthening National Commissioning was to agree to the establishment of the Advisory Group for National Specialised Services (AGNSS).

This new group includes expertise from each of the three groups that were involved in making decisions about the national commissioning portfolio. Its membership was strengthened through patient and lay representation and through experts representing the disciplines of ethics, health economics and pharmacy.

AGNSS makes recommendations directly to Ministers on which  services should be in the national commissioning portfolio. These changes meant that the NCG was dissolved but much of its expertise was retained as many expert members transferred to AGNSS. These changes also allowed the NSCG to fully focus on regional and supra-regional specialised services.