The review of commissioning arrangements for specialised services (the ‘Carter review’) (2006)

The government commissioned an independent review in October 2005 that considered the processes by which specialised health services were commissioned. It was published in May 2006, making recommendations for improvement. The review was instigated as a result of concerns raised about the consistency of commissioning arrangements and the impact of the proposed reorganisation of primary care trusts (PCTs) and strategic health authorities (SHAs) on specialised commissioning.

Specialised services were those that tended to be provided in larger, more specialist acute centres dealing with rare conditions or interventions such as kidney transplants. They were considered to be high-cost but low-volume and tended to be commissioned to cover a large population or geographical area compared with non-specialised services.

PCTs worked together to commission specialised services and were overseen by SHAs. The existing eight specialised commissioning groups (SCGs) commissioned for rare conditions with a planning population of 3–6 million people and 25 local specialised commissioning groups (LSCGs) commissioned for less rare conditions over a planning population of 1–2 million people. The national specialist commissioning advisory group (NSCAG) commissioned services for extremely rare conditions using a budget held by the Department of Health.

The review made 32 recommendations, including the following:

  • an NSSCG should be established to coordinate all specialised service commissioning undertaken by SCGs
  • The NSCAG should become the National Commissioning Group (NCG) to continue commissioning extremely specialised services and to provide advice to ministers
  • SCGs should each have a budget pooled from PCT allocations to cover the specialised services that they commissioned on behalf of PCTs and the associated management costs
  • SHAs needed to robustly performance manage the process of specialised services commissioning.