Specialised Healthcare Alliance

The Alliance is delighted that the Operating Framework for the year commencing April 2008 gives renewed impetus to implementation of the Carter recommendations, especially in relation to pooled budgets and designation of providers. The relevant extract states:

3.11 As a result of the Carter Review, the 10 Specialised Commissioning Groups (SCGs) were created to drive up the quality of specialised services, and prevent wasteful or even unsafe duplication of services. For that reason, we expect SCGs to create pooled budgets and to commission the majority of specialised services on their patch this year, extending this to all specialised services in 2009/10. This year, at least half of specialised services commissioned on each patch should be designated, in order to guarantee patient safety and ensure that scarce

skills are used effectively. This must be done with a regard to published competition principles and rules.

3.12 In commissioning for world-class health services, SCGs should pay particular attention to areas where significant increases in demand are likely to lead to pressure on services. For example, demand for renal replacement therapy (dialysis and transplantation) is projected to rise by around 5 per cent per year until at least 2030. SCGs will wish to consider options for expanding the provision of satellite dialysis centres and offering more people the option of home dialysis, as well as expanding traditional acute dialysis units.

September 2007

NHS Next Stage Review

The Specialised Healthcare Alliance has submitted a response to Lord Darzi's review of the NHS. This highlights the need to treat specialised services as an integral part of the NHS and to involve patients and their advocates in any reconfiguration of services with savings directed back into patient care. The Alliance looks forward to working with Lord Darzi and his team in ensuring that the Next Stage Review places appropriate emphasis on these matters in its final report and recommendations.

June 2007

High cost treatments

The Alliance has developed a policy statement on high cost treatments, pointing out that the NHS's ability to help those in greatest need must not be weakened by the shift towards greater local accountability for the generality of services. With that in mind, the Alliance is seeking support for:

The standard and availability of specialised services being fundamental to a properly functioning National Health Service;
The new commissioning arrangements for specialised services being implemented at the earliest opportunity with sufficient pooled budgets attached;
For services and treatments not covered by Payment by Results, pooled budgets are imperative;
The Department should encourage more consistency of provision of specialised treatments across the country by developing the National Definition Set and including standards of care where appropriate;
Where treatment is not approved, the decision-making process should be more transparent and there should be a clear appeals process for patients with support provided;
The Government's strategy for medical research needs to recognise the role of specialised services in providing a pathway for innovation.

NICE inquiry

The SHCA submitted evidence to the latest Health Select Committee inquiry into NICE. In particular:

The Specialised Healthcare Alliance considers NICE to have a critical role in ensuring that treatment delivered by the NHS is equitable, cost effective and to a uniformly high standard.
The existence in NICE of an independent national forum where decisions about cost effectiveness and prioritisation can be made in a consistent and fair manner is particularly important for patients with specialised medical conditions.
The Alliance believes the Institute's evaluation system should be more transparent. Reform of the process may allow for a fairer consideration of some treatments. In the case of orphan or ultra-orphan treatments social value judgments are likely to be necessary which should rest with parliament.
The Specialised Healthcare Alliance welcomes the recent moves by NICE to ensure lifesaving drugs can be assessed more quickly and supports this process being extended to other technologies.
Unless greater consideration is given to how and when tariffs reflect NICE guidance, patients could face greater delays in accessing recommended treatments.
The Alliance believes that much greater priority should be attached to ensuring the implementation of NICE guidance. If NICE were to assume responsibility for this it would need additional resources.

Future of Payment by Results (PbR)

The SHCA has responded to the latest consultation on the future of PbR. The Alliance sees the tariff system as important for both included and excluded treatments, insofar as the latter might be disadvantaged without robust funding arrangements to ensure stable provision. The slow pace of progress in relation to specialised services is therefore disappointing.

December 2006

NHS Operating Framework

As the SHCA continues a series of meetings with the new Strategic Health Authorities to discuss implementation of the Carter Report and Commissioning Framework, it is pleasing to note that specialised services feature in the new NHS Operating Framework for 2007-08. In particular:

3.26 PCTs are expected to implement the recommendations contained in the Review of Commissioning Arrangements for Specialised Services , published in May 2006, and set out in the Health reform in England : update and commissioning framework .

3.27 SHAs are expected to ensure that effective collaborative commissioning arrangements for specialised services are in place in good time and that business continuity is maintained. Ten Specialised Commissioning Groups (SCGs) will be in place and the National Specialised Services Commissioning Group (NSSCG) will be established to take forward the priorities for 2007/08.

the establishment of the National Commissioning Group (NCG) on the transfer of the National Specialist Commissioning Advisory Group from DH to the NHS;
SCGs to collectively commission a minimum of 10 specialised services; by 2008/09 SCGs to collectively commission most specialised services for their populations.

October 2006

Chair of the SHCA

Baroness Pitkeathley has succeeded Baroness Hayman as Chair of the SHCA following Baroness Hayman's election as the first Speaker of the House of Lords. Jill Pitkeathley has a distinguished record in public service with particularly strong links to the voluntary sector. In the field of health, these presently include positions as president of the Prostate Cancer Charity and Bowel Cancer UK and as vice president of the Parkinson's Disease Society. Baroness Pitkeathley therefore has a very good understanding of the rationale which underlies the Alliance and the need to ensure successful implementation of the new Commissioning Framework as it affects specialised services.

The SHCA also wishes to express its appreciation to Baroness Hayman for the important contribution she has made to its work since 2004.

July 2006

Commissioning Framework

Publication of the Department of Health's Commissioning Framework this month marks an important step in the adoption of the Carter Report's recommendations on specialised commissioning, most of which have been adopted, though important issues such as revision of the National Definition Set remain to be addressed through other channels.

The Alliance will be seeking to work closely with the Department, the Strategic Health Authorities and others to ensure effective implementation of the new structures and processes for specialised commissioning set out in the Framework. The Alliance is also keen to see the earliest possible establishment of the National Specialised Services Commissioning Group, which will have a key role to play in determining priorities and advising on issues such as the development of Payment by Results.

May 2006

Specialised Commissioning Report

The review of specialised commissioning chaired by Professor Sir David Carter at the request of Lord Warner has now been completed. A copy of the full report can be found on the commissioning pages of the Department of Health website ( www.dh.gov.uk ) . The report's key recommendations are summarised in the attached briefing note. Overall, the Alliance is delighted with the outcome of the review. It is, however, important that the recommendations are adopted in full as part of a coherent approach to commissioning in general and that proper attention is given to effective implementation thereafter.

December 2005

Review of specialised commissioning

As an early contribution to the review of specialised commissioning set up by Lord Warner in October, the SHCA has prepared a commentary on the terms of reference, as attached. Members have since reinforced many of the points made at a stakeholder day held on 2 nd December. EDM 762 on specialised commissioning has also attracted support from more than 120 MPs so far, demonstrating what will be keen parliamentary interest in the outcome of the review.

October 2005

Ministerial Task Force

The SHCA is pleased to be represented on a Task Force which has been announced by Lord Warner, DH Minister of State, to look at specialised commissioning in the context of wider NHS reforms with a view to making arrangements more robust.

The Task Force is due to report to ministers by spring 2006 and has the following remit:

To ensure that NHS commissioning for specialised services is fit for purpose and robust in the context of NHS system reform.

To review the current arrangements in the NHS for Specialised Commissioning Groups and Local Specialised Commissioning Groups, as set up following DH guidance in 2002 , and the national commissioning under NSCAG and to identify strengths, weaknesses and existing good practice.
To assess the potential impact of NHS system reform on specialised services and treatments.
To make proposals for improvement in specialised services and treatments commissioning, which fit with work on Implementing a Patient Led NHS, including what should be commissioned nationally
Ensure that proposals keep specialised services commissioning in step with wider NHS reforms and generate consistent arrangements across the country.

Meanwhile, Doug Naysmith MP has tabled an Early Day Motion (No 762) on the subject of specialised commissioning. This reads:

"That this House notes the large number of people affected by the great diversity of specialised medical conditions; considers that the standard and availability of specialised services is fundamental to a properly functioning National Health Service; recognises the vital role of effective specialised commissioning in delivering a patient-led NHS; and calls upon the Government to ensure that robust funding systems are in place to ensure stable provision for these vulnerable patients."

The SHCA is keen for as many MPs as possible to sign the EDM as the Task Force gets underway.

July 2005

Moving up the agenda

A series of policy developments are combining to move specialised commissioning slowly but surely up the agenda, as summarised in the attached paper.

In a debate sponsored by Earl Howe on 11 th July, attention was drawn to the potential impact on specialised services of Payment by Results and Foundation Trusts and to the need for better risk sharing between PCTs . In his response, Lord Warner on behalf of the government undertook to look carefully at specialised commissioning in taking forward wider NHS reform.

April 2005

Standards for Better Health

In a short debate in the House of Lords on 7 April sponsored by Baroness Barker, Lord Warner, responding for the government confirmed that Standards for Better Health published in July 2004 "covers the commissioning by PCTs of specialised and mental health services" and that the Healthcare Commission's assessment system will cover commissioning. He continued:

"The Healthcare Commission will be working with primary care trusts in the coming year to develop ways of measuring and assessing commissioning more effectively. The commission is also planning an improvement review into commissioning and, where relevant, it will examine how effectively services are commissioned as part of the review, which will embrace specialist commissioning. The new criteria document that the Healthcare Commission will publish shortly will refer specifically to the needs of specialist commissioning."

The SHCA is pleased to be represented on a DH group looking at ways of strengthening and improving the coherence of the processes for planning, decision-making and performance management at all levels of specialised commissioning within the NHS.

March 2005

Creating a patient-led NHS

The DH's strategy for implementing the NHS improvement plan shows pleasing signs of putting specialised services closer to the heart of government policy. In particular, there is a commitment to extending clinical networks in a way which is responsive to patients and can introduce new clinical practices quickly. The Alliance looks forward to working with Strategic Health Authorities and the National Leadership Network for Health and Social Care in taking the policy forward.

January 2005

SHCA Manifesto

In what looks likely to be a general election year, the Alliance has sent its own manifesto to all the main political parties, as attached. In particular, the NHS should be judged by the standard and availability of its specialised services, which affect considerable numbers of people, including some of the most vulnerable in society.

January 2005

Payment by Results (PBR)

The SHCA is concerned about the potential impact of PBR on the provision and quality of specialised services. In some cases, national tariffs seem inadequately to reflect the extra costs of specialist providers. In others, specialist treatments have been excluded from PBR but may be financially squeezed if expenditure within the scheme overruns. The Alliance is therefore working with the Royal College of Physicians to set up a nationwide monitoring panel of clinicians to act as an early warning system. Aggregated results from the panel will be posted on the website at regular intervals as the year unfolds, commencing in the spring.

September 2004

Planning Framework 2005-08

The SHCA is delighted that the new DH Planning Framework (National Standards, Local Action) underlines the need for PCTs to collaborate effectively in delivering specialised services. Specifically, paragraph 15 states that in setting local targets:

PCTs will need to take into account specialist services which can only be commissioned effectively on a pan-PCT or still broader basis. PCTs , with SHA support, are expected to act collaboratively to secure these services and their improvement.

The SHCA will be aiming to build on this important statement in its work with key stakeholders. These include the Healthcare Commission, where the Alliance has sought to identify areas for collaboration in the attached document.

June 2004

Parliamentary Seminar

A wide range of Parliamentarians and others attended a breakfast seminar on 8 June 2004 sponsored by the Associate Parliamentary Health Group. The Rt Hon John Hutton MP, Minister of State at the Department of Health gave the keynote address with additional contributions from the SHCA, London Specialised Commissioning Group and a patient advocate.

April 2004

Healthcare Commission

The SHCA welcomes the creation of the Healthcare Commission. Our response to the Commission's corporate plan for 2004-08 highlights a number of ways in which the interests of specialised services could be protected and promoted to the benefit of commissioners, users and providers.

click here to read SHCA Response to Healthcare Commission Corporate Plan 2004-08

(46KB)

April 2004

Standards in Healthcare

The DH has sought views on a range of core and developmental standards for healthcare in England . These are of major importance, not least as a starting point for the work of the Healthcare Commission. The SHCA 's response emphasises the importance of commissioning and specialised services featuring in the standards if the needs of many hundreds of thousands of patients are to be protected as part of an integrated National Health Service.

February 2004

National tariffs

click here to read the SHCA's views on national tariffs and how they might affect specialised services.

Home News Specialised Services Specialised Commissioning Members SHCA Surveys Archive Contact
Archive December 2007 Operating Framework 2008-09 The Alliance is delighted that the Operating Framework for the year commencing April 2008 gives renewed impetus to implementation of the Carter recommendations, especially in relation to pooled budgets and designation of providers. The relevant extract states: Specialised services commissioning 3.11 As a result of the Carter Review, the 10 Specialised Commissioning Groups (SCGs) were created to drive up the quality of specialised services, and prevent wasteful or even unsafe duplication of services. For that reason, we expect SCGs to create pooled budgets and to commission the majority of specialised services on their patch this year, extending this to all specialised services in 2009/10. This year, at least half of specialised services commissioned on each patch should be designated, in order to guarantee patient safety and ensure that scarce skills are used effectively. This must be done with a regard to published competition principles and rules. 3.12 In commissioning for world-class health services, SCGs should pay particular attention to areas where significant increases in demand are likely to lead to pressure on services. For example, demand for renal replacement therapy (dialysis and transplantation) is projected to rise by around 5 per cent per year until at least 2030. SCGs will wish to consider options for expanding the provision of satellite dialysis centres and offering more people the option of home dialysis, as well as expanding traditional acute dialysis units. September 2007 NHS Next Stage Review The Specialised Healthcare Alliance has submitted a response to Lord Darzi's review of the NHS. This highlights the need to treat specialised services as an integral part of the NHS and to involve patients and their advocates in any reconfiguration of services with savings directed back into patient care. The Alliance looks forward to working with Lord Darzi and his team in ensuring that the Next Stage Review places appropriate emphasis on these matters in its final report and recommendations. Click for full document (32KB) June 2007 High cost treatments The Alliance has developed a policy statement on high cost treatments, pointing out that the NHS's ability to help those in greatest need must not be weakened by the shift towards greater local accountability for the generality of services. With that in mind, the Alliance is seeking support for: The standard and availability of specialised services being fundamental to a properly functioning National Health Service; The new commissioning arrangements for specialised services being implemented at the earliest opportunity with sufficient pooled budgets attached; For services and treatments not covered by Payment by Results, pooled budgets are imperative; The Department should encourage more consistency of provision of specialised treatments across the country by developing the National Definition Set and including standards of care where appropriate; Where treatment is not approved, the decision-making process should be more transparent and there should be a clear appeals process for patients with support provided; The Government's strategy for medical research needs to recognise the role of specialised services in providing a pathway for innovation. Click for full document (119KB) NICE inquiry The SHCA submitted evidence to the latest Health Select Committee inquiry into NICE. In particular: The Specialised Healthcare Alliance considers NICE to have a critical role in ensuring that treatment delivered by the NHS is equitable, cost effective and to a uniformly high standard. The existence in NICE of an independent national forum where decisions about cost effectiveness and prioritisation can be made in a consistent and fair manner is particularly important for patients with specialised medical conditions. The Alliance believes the Institute's evaluation system should be more transparent. Reform of the process may allow for a fairer consideration of some treatments. In the case of orphan or ultra-orphan treatments social value judgments are likely to be necessary which should rest with parliament. The Specialised Healthcare Alliance welcomes the recent moves by NICE to ensure lifesaving drugs can be assessed more quickly and supports this process being extended to other technologies. Unless greater consideration is given to how and when tariffs reflect NICE guidance, patients could face greater delays in accessing recommended treatments. The Alliance believes that much greater priority should be attached to ensuring the implementation of NICE guidance. If NICE were to assume responsibility for this it would need additional resources. Click for full document (128KB) Future of Payment by Results (PbR) The SHCA has responded to the latest consultation on the future of PbR. The Alliance sees the tariff system as important for both included and excluded treatments, insofar as the latter might be disadvantaged without robust funding arrangements to ensure stable provision. The slow pace of progress in relation to specialised services is therefore disappointing. Click for full document (123KB) December 2006 NHS Operating Framework As the SHCA continues a series of meetings with the new Strategic Health Authorities to discuss implementation of the Carter Report and Commissioning Framework, it is pleasing to note that specialised services feature in the new NHS Operating Framework for 2007-08. In particular: 3.26 PCTs are expected to implement the recommendations contained in the Review of Commissioning Arrangements for Specialised Services , published in May 2006, and set out in the Health reform in England : update and commissioning framework . 3.27 SHAs are expected to ensure that effective collaborative commissioning arrangements for specialised services are in place in good time and that business continuity is maintained. Ten Specialised Commissioning Groups (SCGs) will be in place and the National Specialised Services Commissioning Group (NSSCG) will be established to take forward the priorities for 2007/08. 3.28 Key milestones for 2007/08 are: the establishment of the National Commissioning Group (NCG) on the transfer of the National Specialist Commissioning Advisory Group from DH to the NHS; SCGs to collectively commission a minimum of 10 specialised services; by 2008/09 SCGs to collectively commission most specialised services for their populations. October 2006 Chair of the SHCA Baroness Pitkeathley has succeeded Baroness Hayman as Chair of the SHCA following Baroness Hayman's election as the first Speaker of the House of Lords. Jill Pitkeathley has a distinguished record in public service with particularly strong links to the voluntary sector. In the field of health, these presently include positions as president of the Prostate Cancer Charity and Bowel Cancer UK and as vice president of the Parkinson's Disease Society. Baroness Pitkeathley therefore has a very good understanding of the rationale which underlies the Alliance and the need to ensure successful implementation of the new Commissioning Framework as it affects specialised services. The SHCA also wishes to express its appreciation to Baroness Hayman for the important contribution she has made to its work since 2004. July 2006 Commissioning Framework Publication of the Department of Health's Commissioning Framework this month marks an important step in the adoption of the Carter Report's recommendations on specialised commissioning, most of which have been adopted, though important issues such as revision of the National Definition Set remain to be addressed through other channels. The Alliance will be seeking to work closely with the Department, the Strategic Health Authorities and others to ensure effective implementation of the new structures and processes for specialised commissioning set out in the Framework. The Alliance is also keen to see the earliest possible establishment of the National Specialised Services Commissioning Group, which will have a key role to play in determining priorities and advising on issues such as the development of Payment by Results. May 2006 Specialised Commissioning Report The review of specialised commissioning chaired by Professor Sir David Carter at the request of Lord Warner has now been completed. A copy of the full report can be found on the commissioning pages of the Department of Health website ( www.dh.gov.uk ) . The report's key recommendations are summarised in the attached briefing note. Overall, the Alliance is delighted with the outcome of the review. It is, however, important that the recommendations are adopted in full as part of a coherent approach to commissioning in general and that proper attention is given to effective implementation thereafter. Click here (63KB) December 2005 Review of specialised commissioning As an early contribution to the review of specialised commissioning set up by Lord Warner in October, the SHCA has prepared a commentary on the terms of reference, as attached. Members have since reinforced many of the points made at a stakeholder day held on 2 nd December. EDM 762 on specialised commissioning has also attracted support from more than 120 MPs so far, demonstrating what will be keen parliamentary interest in the outcome of the review. Click here (65KB) October 2005 Ministerial Task Force The SHCA is pleased to be represented on a Task Force which has been announced by Lord Warner, DH Minister of State, to look at specialised commissioning in the context of wider NHS reforms with a view to making arrangements more robust. The Task Force is due to report to ministers by spring 2006 and has the following remit: Overall Objective To ensure that NHS commissioning for specialised services is fit for purpose and robust in the context of NHS system reform. Terms of Reference To review the current arrangements in the NHS for Specialised Commissioning Groups and Local Specialised Commissioning Groups, as set up following DH guidance in 2002 , and the national commissioning under NSCAG and to identify strengths, weaknesses and existing good practice. To assess the potential impact of NHS system reform on specialised services and treatments. To make proposals for improvement in specialised services and treatments commissioning, which fit with work on Implementing a Patient Led NHS, including what should be commissioned nationally Ensure that proposals keep specialised services commissioning in step with wider NHS reforms and generate consistent arrangements across the country. Early Day Motion Meanwhile, Doug Naysmith MP has tabled an Early Day Motion (No 762) on the subject of specialised commissioning. This reads: "That this House notes the large number of people affected by the great diversity of specialised medical conditions; considers that the standard and availability of specialised services is fundamental to a properly functioning National Health Service; recognises the vital role of effective specialised commissioning in delivering a patient-led NHS; and calls upon the Government to ensure that robust funding systems are in place to ensure stable provision for these vulnerable patients." The SHCA is keen for as many MPs as possible to sign the EDM as the Task Force gets underway. July 2005 Moving up the agenda A series of policy developments are combining to move specialised commissioning slowly but surely up the agenda, as summarised in the attached paper. In a debate sponsored by Earl Howe on 11 th July, attention was drawn to the potential impact on specialised services of Payment by Results and Foundation Trusts and to the need for better risk sharing between PCTs . In his response, Lord Warner on behalf of the government undertook to look carefully at specialised commissioning in taking forward wider NHS reform. Click here (74KB) April 2005 Standards for Better Health In a short debate in the House of Lords on 7 April sponsored by Baroness Barker, Lord Warner, responding for the government confirmed that Standards for Better Health published in July 2004 "covers the commissioning by PCTs of specialised and mental health services" and that the Healthcare Commission's assessment system will cover commissioning. He continued: "The Healthcare Commission will be working with primary care trusts in the coming year to develop ways of measuring and assessing commissioning more effectively. The commission is also planning an improvement review into commissioning and, where relevant, it will examine how effectively services are commissioned as part of the review, which will embrace specialist commissioning. The new criteria document that the Healthcare Commission will publish shortly will refer specifically to the needs of specialist commissioning." DH Steering Group The SHCA is pleased to be represented on a DH group looking at ways of strengthening and improving the coherence of the processes for planning, decision-making and performance management at all levels of specialised commissioning within the NHS. March 2005 Creating a patient-led NHS The DH's strategy for implementing the NHS improvement plan shows pleasing signs of putting specialised services closer to the heart of government policy. In particular, there is a commitment to extending clinical networks in a way which is responsive to patients and can introduce new clinical practices quickly. The Alliance looks forward to working with Strategic Health Authorities and the National Leadership Network for Health and Social Care in taking the policy forward. January 2005 SHCA Manifesto In what looks likely to be a general election year, the Alliance has sent its own manifesto to all the main political parties, as attached. In particular, the NHS should be judged by the standard and availability of its specialised services, which affect considerable numbers of people, including some of the most vulnerable in society. Click here (71KB) January 2005 Payment by Results (PBR) The SHCA is concerned about the potential impact of PBR on the provision and quality of specialised services. In some cases, national tariffs seem inadequately to reflect the extra costs of specialist providers. In others, specialist treatments have been excluded from PBR but may be financially squeezed if expenditure within the scheme overruns. The Alliance is therefore working with the Royal College of Physicians to set up a nationwide monitoring panel of clinicians to act as an early warning system. Aggregated results from the panel will be posted on the website at regular intervals as the year unfolds, commencing in the spring. September 2004 Planning Framework 2005-08 The SHCA is delighted that the new DH Planning Framework (National Standards, Local Action) underlines the need for PCTs to collaborate effectively in delivering specialised services. Specifically, paragraph 15 states that in setting local targets: PCTs will need to take into account specialist services which can only be commissioned effectively on a pan-PCT or still broader basis. PCTs , with SHA support, are expected to act collaboratively to secure these services and their improvement. The SHCA will be aiming to build on this important statement in its work with key stakeholders. These include the Healthcare Commission, where the Alliance has sought to identify areas for collaboration in the attached document. Click here (64KB) June 2004 Parliamentary Seminar A wide range of Parliamentarians and others attended a breakfast seminar on 8 June 2004 sponsored by the Associate Parliamentary Health Group. The Rt Hon John Hutton MP, Minister of State at the Department of Health gave the keynote address with additional contributions from the SHCA, London Specialised Commissioning Group and a patient advocate. Click here to read a summary of the meeting. (63KB) April 2004 Healthcare Commission The SHCA welcomes the creation of the Healthcare Commission. Our response to the Commission's corporate plan for 2004-08 highlights a number of ways in which the interests of specialised services could be protected and promoted to the benefit of commissioners, users and providers. click here to read SHCA Response to Healthcare Commission Corporate Plan 2004-08 (46KB) April 2004 Standards in Healthcare The DH has sought views on a range of core and developmental standards for healthcare in England . These are of major importance, not least as a starting point for the work of the Healthcare Commission. The SHCA 's response emphasises the importance of commissioning and specialised services featuring in the standards if the needs of many hundreds of thousands of patients are to be protected as part of an integrated National Health Service. click here to read the SHCA Standards Response (108KB) February 2004 National tariffs click here to read the SHCA's views on national tariffs and how they might affect specialised services.



For further information about commissioning for rare diseases and complex conditions contact: enq@scha.info

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Archive

Operating Framework 2008-09

September 2007

NHS Next Stage Review

June 2007

High cost treatments

NICE inquiry

Future of Payment by Results (PbR)

December 2006

NHS Operating Framework

October 2006

Chair of the SHCA

July 2006

Commissioning Framework

May 2006

Specialised Commissioning Report

December 2005

Review of specialised commissioning

October 2005

Ministerial Task Force

July 2005

Moving up the agenda

April 2005

Standards for Better Health

March 2005

Creating a patient-led NHS

January 2005

SHCA Manifesto

January 2005

Payment by Results (PBR)

September 2004

Planning Framework 2005-08

June 2004

Parliamentary Seminar

April 2004

Healthcare Commission

April 2004

Standards in Healthcare

February 2004

National tariffs