GUIDANCE ON PROPOSING NATIONAL COMMISSIONING OF SERVICES

National Specialist Services Committee NSSC GUIDANCE ON PROPOSING NATIONAL COMMISSIONING OF SERVICES The National Specialised Services Committee (NSSC) is responsible for recommendations to the NHS Board Chief Executives Group (BCEs) and to the Scottish Government Health and Social Care Directorates (SGHSCD) on the commissioning of highly specialised services for patients in Scotland with complex needs or rare conditions. This includes recommending: Entry to National Commissioning NSSC will review proposals for national designation of specialist health services and Managed Clinical Networks and will make recommendations on whether national commissioning is appropriate for each of the proposed national services/networks. Proposals for national services/networks might arise from service planning by SGHSC, the National Planning Forum, Regional Planning Groups and NHS Boards; or they might be applications from clinicians for designation of specific services/networks which are supported by their NHS Board(s). NSSC will apply the criteria to all new proposals and advise on any necessary prioritisation between proposals for national commissioning. Further details of the methods used by NSSC will be made available on www.nsd.scot.nhs.uk Renewal of Designation NSSC will also make recommendations on service reviews and the renewal of designation of existing nationally commissioned services. Details of the review and renewal of designation can be found on www.nsd.scot.nhs.uk Scope of National Commissioning NSSC will consider the suitability for national commissioning of services which meet the NSSC entry criteria. The service is of proven effectiveness The service is for a condition requiring diagnosis and/or treatment that is rare and/or unpredictable. Designated services will usually involve no more than 500 patients (one year period prevalence). Designated services also normally have a low incidence. The service is person centred and meets a recognised need for all residents of Scotland within a clearly defined clinical area. Provision requires a highly skilled multidisciplinary team and/or specialist equipment and facilities that can be provided clinically and cost effectively in one, or only a few, locations. The service requires scarce clinical skills. The clinical need for national commissioning of the service is significant and well defined. There is a clear clinical pathway for the service including criteria for referring patients and a co-ordination strategy for conditions that are provided by more than one clinical specialty. The target patient group or subset is distinct for clinical reasons. There will be significant benefits from national commissioning and concentrated provision, which might include improved clinical quality, focused clinical expertise, more efficient use of NHS resources. The service will have a greater clinical benefit than alternative forms of care. 07 HSS\Cttees & Grps\Policy Grps\NSSC\Admin\Format for NSSC Proposals\Guidance on Proposals 1

The service can demonstrate/has an explicit plan to provide the service equitably to all patients who are eligible for NHS treatment in Scotland. There is enough evidence to determine that the service will be cost effective. For high-cost services It is expected that the clinical benefits would be observed in a large proportion of the patients treated (for lifelong treatment this is likely to be close to 100%, i.e., that the number needed to treat approaches one). Three Stage Process for Consideration of Proposals Stage 1 Proposing body/applicant to email a short paragraph to National Services Division (NSD) describing service; number of patients expected in Scotland; why applicant considers it requires designation as a national specialist service. National Services Division will contact proposer by telephone to find out more about the proposal and to explore with the proposer whether service likely to meet criteria Proposing body/applicant will be informed if it is clear that proposal does/does not meet criteria If proposal appears to meets criteria applicant will be invited to complete a short Outline Proposal in the required format. Stage 2 Proposer submits 3-4 page Outline Proposal to NSD for NSSC together with the Chief Executive s support (see appendix C, C(i), C(ii), C(iii) and C(iv)). Outline proposal received and put onto the agenda for a meeting of NSSC s advisory group - the National Patient, Public and Professional Reference Group (NPPPRG). NPPPRG will consider if eligible for designation and decide whether to invite submission of a Full Proposal. If service meets criteria: NPPPRG will invite proposer to complete a Full Proposal to NSSC (with support from the NSD Commissioning Team). In some areas especially where a gap in provision has been identified and proactive planning is required to agree the potential solution, NPPPRG may decide to recommend to NSSC that a short life sub group be established to work up a Full Proposal. If sub group required NSD would support the sub group in developing a Full Proposal. If NPPPRG considers service is not eligible for designation: NSD will advise proposer. Stage 3 Full Proposal received. Initial detailed consideration will be undertaken by the National Patient, Public and Professional Reference Group (NPPPRG). Further information may be sought if there is insufficient information in the proposal to make a recommendation to NSSC. 07 HSS\Cttees & Grps\Policy Grps\NSSC\Admin\Format for NSSC Proposals\Guidance on Proposals 2

NPPPRG make recommendation to NSSC: NPPPRG to create a cover sheet setting out key points and recommendation on national commissioning and submit to National Specialist Services Committee (NSSC). NSSC to discuss, consider affordability and priority for national designation of proposal, and decide on recommendation to BCEs and SGHSCD. NSSC make recommendation to BCEs and SGHSCD: If NSSC recommend designation, NSD will inform the proposer and will submit NSSC s recommendation to BCEs and SGHSCD. If NSSC recommend against designation, NSD will inform the proposer. All proposals need to be with National Services Division 6 weeks before an NSSC meeting. The proposal will firstly be considered by NPPPRG (which will be held 3 weeks before an NSSC meeting) and then submitted with NPPPRG s advice to NSSC. Advice to proposers/applicants Proposers/applicants should note that the NSSC will treat all information provided in support of a proposal as in the public domain unless it is informed otherwise. Guidance on completion of a stage 2 Outline proposal is set out in Appendix C. The financial information required at outline proposal stage is set out in Appendix C(iv). The questions in the full proposal (Appendix D) build on those in the outline proposal, but include additional information and require more detailed responses. The name of a lead NSD commissioner, who will be the key point of contact in developing the full proposal, will have been communicated to proposers/applicants along with the successful outcome of their outline proposal. Where the National Patient, Public and Professional Reference Group (NPPPRG) has raised specific questions about individual outline proposals, these will have also been communicated to proposers/applicants at that time, and will need to be addressed in their full proposal. Guidance on completing a Stage 3 Full proposal are set out in Appendix D(iv). This provides a detailed explanation of the questions in the proposal and examples of the types of supporting evidence that can be provided in their response. Responses to the questions in the proposal should provide: The best quality and most recent evidence, which is available Realistic predictions of future need for the provision of the proposed product, service or technology All questions of the proposal should be completed where possible, or applicants should explicitly state that no relevant information is available. The Committee will take a view on whether the evidence provided is sufficient to enable appropriate consideration of the proposal at this time, and may recommend that the proposal is re-submitted at a later time in order to allow for the collection of stronger supporting evidence. It is therefore in the interests of applicants to complete each section of the proposal. New proposers/applicants will be provided with additional support by NSD as to the most appropriate evidence to provide. One proposal should be submitted per service or network. This should be submitted by an agreed lead proposer/applicant and should include details from all provider centres, as well as summary details for the provision as a whole. 07 HSS\Cttees & Grps\Policy Grps\NSSC\Admin\Format for NSSC Proposals\Guidance on Proposals 3

Applicants should ensure that Appendix C(iii) and D(v) is completed for each centre that wishes to be nationally designated. It is essential that the comprehensive contact details are given for each proposed centre so that queries can be followed up promptly. Financial and activity information It is critical to the success of full proposals that the detailed financial information requested in Appendix E is submitted for each centre that is proposed to be nationally designated alongside the rest of the proposal, with a clear explanation of any assumptions made. Particular points to note are as follows: Proposers/applicants are strongly advised to work with their fellow NHS Boards/centres from the outset in the development of costing information. In most cases, NSSC will expect to pay the same unit cost, for the same service/intervention, wherever it takes place. If applicants propose that different unit costs should be paid at different locations, they must demonstrate why this is the case. Any differences in final costs reflecting variations in the staffing, skill mix, consumables, hospital overheads must be clearly illustrated. Proposers/applicants should demonstrate both the full costs of providing the service and the net cost of the service to NHS Scotland, net of any existing income. They should also detail existing income streams and/or savings that will be made from reductions in expenditure in other existing services by disinvestment to show the net increase in cost to the NHS. Proposers/applicants should also identify any non-nhs Scotland income streams currently supporting the service and detail whether or not these are ongoing, for example, any elements of university or charitable funding, or income from outside Scotland. Details of any anticipated income from sources other than the NHS in Scotland should also be provided. Applicants should provide estimates of the minimum amount required for maintaining a basic provision of the proposed product, service or technology. If possible, applicants should provide an estimate of the total annual cost burden to society that could be avoided by providing the proposed product, service or technology. Examples could include estimates of the reduced burden to carers/families, estimates of financial impacts of any risk to the public, etc. Appendix D(i) (proforma for Director of Finance support individual centres) must be completed for each centre that wishes to be nationally designated. The Director of Finance at the lead centre must also complete Appendix D(ii) (proforma for lead Director of Finance support whole proposal). Applicants should also complete the activity table in Appendix E, giving information for each centre that wishes to be nationally designated. Summary of documents associated with proposal for national commissioning and designation: Stage 1 Guidance on proposing National Commissioning of Services Appendix A: Proposal Process Appendix B: Proforma for Stage 1 Proposal Stage 2 Appendix C: Guidance on how to complete an outline proposal Appendix C(i): Criteria Outline Proposal Evaluation Template Appendix C(ii): Proforma for Chief Executive Support Appendix C(iii): Proforma for Centre Information Appendix C(iv): Finance proformas for information required at outline stage. Stage 3 Appendix D: Proforma for Full Proposal for National Commissioning and Designation (Full Proposal stage only) 07 HSS\Cttees & Grps\Policy Grps\NSSC\Admin\Format for NSSC Proposals\Guidance on Proposals 4

Appendix D(i): Proforma for Director of Finance support Individual Centres (Full Proposal stage only) Appendix D(ii): Proforma for Director of Finance support Whole Proposal (Full Proposal stage only) Appendix D(iii) Proforma for Chief Executive Support Appendix D(iv): Notes for completion of the Full Proposal Appendix D(v): Proforma for Centre Information (Outline and Full Proposal stages) Appendix E: Financial and Activity Proforma for Full Proposal for National Commissioning and Designation (Full Proposal stage only) Criteria and process for consideration of full proposals At the full proposal stage, proposals will be assessed for evidence submitted under each of the following criteria, laid out in the Framework for decision making on national commissioning: Severity and ability of patients to benefit Clinical safety and risk Clinical effectiveness & potential for improving health Stimulating research and innovation Needs of and benefits to patients and society Average cost per patient Overall cost impact and affordability including opportunity cost Value for money compared to alternatives Best clinical practice in delivering the service Economic efficiency of provision Continuity of provision Accessibility and balanced geographic distribution Proposals will be considered in a decision-making process, which will follow principles of good practice. The process will: Be transparent and accountable Support rational decision making Demonstrate how the evidence has been considered in a robust and documentable process, able to withstand legal challenge Maintain consistency but allow some flexibility in balancing the relative importance of criteria and criteria groups Ensure that criteria and implementation are reviewed regularly to incorporate changes in external context Consider the best quality evidence, which is available Be based on realistic predictions of future need Use clear criteria, which should be used as a structure for the evaluation and decision-making process Seek to promote accessibility and equity and reflect societal values Seek to support improvements to economically efficient or clinically effective service provision The criteria, principles, and overall process for consideration of proposals will be reviewed on a regular basis to improve effectiveness, incorporate learning and adapt to external changes. Proposers/applicants should note that, at the full application stage, NSSC needs to prioritise proposals. In some cases, a health technology appraisal may need to be commissioned in order for NSSC to make a final recommendation on a particular proposal. In these cases, NSSC may issue a preliminary recommendation, conditional on the outcome of consideration by the Scottish Health Technology Group (SHTG). It is also important to recognise that the recommendation issued by NSSC is not the final decision and it requires both endorsement by the NHS Board Chief Executives Group and Ministerial approval before a proposal can go on to be commissioned. 07 HSS\Cttees & Grps\Policy Grps\NSSC\Admin\Format for NSSC Proposals\Guidance on Proposals 5

Contacts for National Specialist Services Committee (NSSC) and National Patient, Public and Professional Reference Group (NPPPRG) National Services Division Area 062 Gyle Square 1 South Gyle Crescent Edinburgh EH12 9EB Tel: (0131) 275 6575 Fax: (0131) 275 7614 NSSC/NPPPRG Secretary Mrs Deirdre Evans Director deirdre.evans@nhs.net Assistant Secretary (NSSC) Mrs Ruth Meechan MBE Planning & Performance Manager ruth.meechan@nhs.net Assistant Secretary (NPPPRG) Miss Pauline Tollins Planning & Performance Co-ordinator pauline.tollins1@nhs.net Clinical Advisers Dr Mike Winter Medical Director mike.winter@nhs.net Miss Katherine Collins Nursing & Quality Adviser katherine.collins@nhs.net Finance Adviser Mr Peter Croan Head of Finance & Operations peter.croan@nhs.net 07 HSS\Cttees & Grps\Policy Grps\NSSC\Admin\Format for NSSC Proposals\Guidance on Proposals 6