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National Services Division Commissioning for Scotland's Health

Specialist Services (UK and EU)

Services provided in England for residents of Scotland

NSD funds services provided in England through two distinct funding streams:

  • a contribution to the NHS England for Scottish access to highly specialist services which are provided on a UK basis.  Access is ensured through a service agreement.
  • by managing a pool of funds (risk share scheme) on behalf of NHS Boards to pay for individual patient referrals for a “prescribed” list  of specialised services in England which are not included in the service agreement with NHS England.

Further information on NHS England can be accessed through the external website below:

UK and English prescribed specialist services

The NHS Commissioning Board (NHS England) is responsible for commissioning a list of over 130 specialised clinical services, prescribed in legislation. The list can be accessed through the link below. These include a small group of around 70 highly specialist services. Some services for very rare conditions, or for highly complex clinical needs, are only available at one or two sites in the UK.

NSD funds Scottish access to the list of prescribed services, some directly and some through our service agreement with NHS England. Further information on the list of prescribed specialist services is available from the following external website:

A full list of nationally funded services for residents of Scotland is available in the document below:

List of Nationally funded services.pdf (81kb)

The clinical performance services provided in England is not monitored directly by NSD in the same way as designated national specialist services in Scotland. Instead NSD works with colleagues in NHS England who are responsible for ensuring the quality of specialised services in England. The service provided by NSD is primarily a financial arrangement through which NSD meets the costs of specialist patient treatment in England on behalf of NHS Boards from pooled funds.  All decisions on appropriate treatment for any individual referred to England remain the responsibility of the NHS Board of the patient's residence.

NSD only funds treatment in England if:

  • The treatment is specialised and is included within the UK Prescribed List of specialised services
  • The treatment is provided in the NHS (not private) in England (not abroad)
  • The service is not provided in Scotland; and
  • The referral is from an appropriate tertiary specialist consultant in Scotland.

Decisions on funding are made on an individual referral basis by a virtual panel at NSD comprising the Medical Director, Nursing and Quality Adviser, and NSD Director.

Costs in 2012/13 were approximately £11m.

The prescribed list of specialised services does not cover all care within England. Non-specialised elements of care continue to be funded by NHS Boards. These definitions do not extend to funding of services in Scotland, Wales or Northern Ireland.

The Chief Executive Letter setting out Scottish Government policy on the “Responsible Commissioner” can be accessed at the external Scottish Government website:

Scottish Government. CEL 2013(06) Establishing the responsible commissioner: Guidance and directions for health boards, March 2013 [31 pages]

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European cross-border healthcare: Services that require prior authorisation

There are 143 specialised services that need prior approval under the European Cross-border Healthcare Directive.

These services are outlined in detail in the NHS England document:

Prescribed Specialised Services Manual PDF (External website) (1.89 MB)

The Manual is the technical document that describes the 143 specialised services prescribed by the Department of Health for centralised commissioning. This is the list of specialist health services on which prior approval is required under the EU Directive if costs are to be recompensed by NHS Boards in Scotland. It is the same list used in NHS England.

It should be read in conjunction with the NHS England National Tariff Document (NTD) which is to be published later this year by NHS England and Monitor. This document will set out the prices for the services on the UK prescribed list.

In the meantime an indicative tariff list for the UK highly specialist services can be accessed below:

Actvity measures for inclusion on the Overseas Vistors Portal & Unit Cost to be used by DWP for recovery [42Kb .xlsx file]

National Services Division works closely with local NHS Boards to administer the approvals and funding for specialist services in Europe which require prior approval. You should contact your local NHS Board to discuss whether prior authorisation is necessary in your individual case, if this is unclear. More details can be accessed on the NHS Inform Website below:

National Services Division contact:

Jean Travers, Commissioning Analyst

To contact members of NSD staff, please visit our staff contacts page.