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Arden & GEM CSU > Case Studies > NHS England Specialised Commissioning turnaround programme

NHS England Specialised Commissioning turnaround programme


NHS England is responsible for commissioning over £15 billion of specialised services, ranging from secure inpatient mental health services to treating life threatening genetic disorders.

Historically, the commissioning of specialised services was managed across ten regional teams, which had led to issues regarding inconsistency and a lack of overall control over performance and rising costs.

Faced with an £800m overspend, NHS England commissioned Arden & GEM Commissioning Support Unit (CSU) to lead a recovery programme. By rapidly mobilising a team of experts and putting in place robust project management, Arden & GEM helped regain control of resources and established improved systems and processes to get the commissioning of specialised services back on track and ensure it could be managed more effectively and sustainably going forward.

The challenge

Commissioning of specialised services is a particularly challenging area, where a few hospitals provide the specialist support needed for a relatively small number of patients. This adds complexity to decision-making around funding and ensuring patients have equal access to the services they need.

Previously managed by Primary Care Trusts, the commissioning of specialised services was being run by ten regional teams under the helm of NHS England. As a result, services were fragmented, systems and processes were inconsistent and there were insufficient management controls in place to ensure commissioning was effective and efficient.

This had led to rising costs and a forecast overspend of £800m. Urgent action was required to stabilise the situation and to tackle the root causes of the problems to prevent the issues from reoccurring.

Developing a solution

Arden & GEM rapidly put in place a strong management team led by a skilled Arden & GEM programme director, bringing together experienced financial directors from across the public and private sectors, medical and operational expertise and a specialised support team to aid delivery.

Then main objectives of the team were to:

  • Establish nationally consistent controls over all aspects of performance
  • Deliver consistent and robust 1-2 and 3-5 year plans
  • Improve the pace and delivery of procurement
  • Ensure a national consistent QIPP programme to improve care and reduce costs
  • Establish a national approach to benchmarking variation and a carry out a robust review of invoice validation opportunities
  • Carry out a targeted approach to utilisation reviews to establish whether patients are receiving the right levels of care in the right settings at the right time.

Robust project management was vital throughout the programme, which involved daily update calls and weekly team meetings to monitor progress and ensure the programme stayed on track.

A focused action plan was developed, concentrating on five key strands. This included:

  • Project management and operational planning – putting in place programme governance procedures, deploying a national reporting tool and monitoring contracts
  • QIPP and utilisation reviews – targeted utilisation reviews to identify QIPP opportunities and supporting the development of a national QIPP programme
  • Performance management – designing a national reporting framework for specialised commissioning and establishing a national team of supplier/contract managers, developing tools and templates for standardised data collection and putting in place a resilient governance structure
  • Clinical procurement – leading strategic procurement programmes across specialised services, putting in place cost-reducing strategies for procurement and market management and providing senior supply chain expertise in specialised clinical categories
  • Complex data analytics – developing an approach to national benchmarking in partnership with KPMG and Optum, cleansing existing data to provide consistent and reliable management information and putting in place bespoke technology to identify potential invoice challenge.


By swiftly mobilising an expert team and driving an intensive programme of work, we were able to stabilise the situation quickly. Within three months, the overspend had been cut by more than half and by nine months the service was back within budget.

The programme not only worked to cut short-term costs but to tackle the underlying issues and ensure a consistent and sustainable national approach which could be effectively delivered at a local level.

With stronger reporting and performance measures in place, services are commissioned and monitored more effectively. Procurement costs have been reduced and savings are being made through greater use of economies of scale. Furthermore, through the creation of a national QIPP programme, the team identified potential savings of over £13 billion.

Prior to the programme, approximately 40% of the data for specialised services was not fit for purpose. There is now a consistent and effective process for collecting, sharing and managing quality data, which now underpins specialised commissioning, ensuring decisions are based on robust evidence.

Once all the key components were in place, the specialised transformation team handed over the new approach and provided support to existing teams to ensure the new ways of working were fully embedded.


It has been great working with the Arden & GEM Clinical Systems team in the development of the Locality Based MDT Unit. The new unit is delivering a range of benefits including, streamlining the referral process from Primary Care, improved communications with GP’s, simplified data collection and easy access to activity and performance data. The team have been responsive, effective and provided us with excellent training on the new system.
Programme Manager Whole System Integration, Milton Keynes CCG and Milton Keynes Council.

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