Following the formation of the Coalition Government in 2010, a new policy framework was announced for the NHS entitled Shaping the Future in which a major reorganisation of the NHS in England was planned to occur over a 3 year period for implementation in April 2013. Concentrating on bringing the commissioning of heath & social care closer to local units and population, the previous structure of 10 SHA’s and 152 PCT’s have been replaced by one National Commissioning Board (NCB -entitled NHS England) with 211 Clinical Commissioning Groups (CCGs) in 4 Regions and 27 Local Area Teams (LATs) .The NCB will commission all the Primary Care Services across England. The existing NHS individual centralised structures in Wales, Scotland and Northern Ireland will continue as present.
Impact on Cochlear Implants
Cochlear implant treatment is a specialised medical service and as such has previously been supervised by the former Specialised Commissioning Groups (SCG) both at the SHA level and the Local PCT level. Formerly these bodies proliferated and there was evidence of a lack of cohesion. To date there have been no coordinated Commissioning Policies or Guidelines. The NCIUA participated in a project under the DoH , together with all the major deaf organisations and User Groups, to fill this vital gap. The result, a comprehensive publication, Cochlear Implant Services - Commissioning Guidelines, was submitted to the NHS
Future Situation for Cochlear Implantation after 1st April 2013
Cochlear implant treatment for all ages will remain a specialised medical service and will (together with Bone Anchored Hearing Aids (BAHA), Auditory Brainstem Implants (ABI), Middle Ear Implantable Hearing Aids (MEIHA) ) come under Specialised Ear Surgery(SES). This unit is one of 16 groups of specialised sets within a Clinical Reference Group (CRG) named Trauma , itself one of 5 CRGs under the National Clinical Director for Specialised Services.
The 27 LATs across England will all have the same core functions; Primary Care, Public Health and local relationship management including CCG development and assurance, and quality and safety. There will however be a variation around the discharge of direct commissioning responsibilities.
Ten of the 27 LATs will lead locally on specialised services contracting across England.
The core function of these 10 LAT leading on specialised services is operational delivery and contracting. There is an explicit difference between commissioning and contracting within the Operating Model; all commissioning (i.e. setting priorities and strategic direction) is done nationally; all contracting and the prime focus for local relationship management with providers is through the named ten LATs. Each of the ten LATs will hold a single NHS CB contract with providers in their area for all agreed service provision for specialised services .They will contract for all of the population across England with those providers. All funding for individual candidates will come from that persons local CSG and the application process is explained here
Thus with a new Specification for cochlear implants (see here) together with the national criteria for cochlear implantation as set out by NICE in 2009 (see here) it is expected that uniform standards, treatment and funding for cochlear implantation will be achieved throughout all regions of England.
A full explanation of the organisation of Specialised Services can be seen at here