National designation is only possible after careful consideration of the cost and clinical effectiveness of the proposed service by the National Specialist Services Committee, the NHS Board Chief Executives’ Group and thereafter by the Scottish Government Health Directorates (SGHD). This can be a complex process as for a service to be recommended for national designation, it must meet several distinct and detailed criteria and demonstrate a measurable benefit to patient care.
Screening programmes are designed to detect early signs of disease in the population and then to provide a reliable method of referral for diagnostic testing and further treatment. Screening in itself is not indicative of the presence of disease, but in order for a screening programme to be considered for national designation, it must be acceptably accurate and designed to test for a disease where earlier detection and intervention would be of benefit to the patient.
National Managed Clinical Networks (NMCNs) exists with the purpose of establishing links and encouraging the sharing of experience of the various groups of professionals involved in the care of people across the country, who have particular and often complex needs. They aim to develop and implement nationally agreed guidelines and protocols, thus ensuring best practice, equity of access and consistency of treatment for all patients. Each NMCNs must demonstrate a significant improvement in the quality and effectiveness of a service including clinical outcomes, assessed from the perspective of the overall patient journey.
Specialist services are commissioned in the rest of the UK by NSD on behalf of all Scottish NHS Boards. The range of services is diverse, including medical, surgical and scientific services for both adults and children. The common link is the rarity of the condition, procedure or treatment and the need for specialist expertise in providing the required patient care. Ensuring equity of access to these services for all residents of Scotland is one of the key drivers behind national designation.
NSD have been funding specialist services delivered to residents of Scotland by English NHS Trusts since 1 April 2002. Referrals to these services are predominantly for treatments which are not available within Scotland, although some referrals are for social reasons, to allow people to receive their care close to their families. Individual patient costs range from outpatient appointments (c.£50) to highly specialised mental health packages of care (c.£400k).
Costs in 2006/07 were £7.8m, a rise of 50% over the previous year. A significant reason for this was that emergency treatments were added to the list of chargeable procedures, resulting in a large increase in critical care costs. There was also an increase in referrals to inpatient specialised mental health, where costs rose from £1.4m in 2005/06 to £2m in 2006/07.
In areas of very high costs for individual patients, NHS Boards have introduced arrangements to pool funding across Scotland to share the financial impact. These cover coagulation factors for the care of people with haemophilia and haemostasis disorders and enzyme replacement therapy for the care of people with lysosomal storage disorders. NSD manages these risk-sharing arrangements on behalf of the Boards, and the range of therapies covered by these arrangements is reviewed by NHS Boards annually.
For information on new developments in the form of new programmes or projects that NSD is involved in, please follow the link below.
Please follow this link for more information on how to apply for national designation.