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We are a partnership of NHS, councils, and voluntary sector organisations, working together to improve health and care in Barnet, Camden, Enfield, Haringey, and Islington.  

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Specialised services

Specialised services support people with a range of rare and complex conditions. These services often involve treatments provided to patients with rare cancers, genetic disorders or complex medical or surgical conditions.

They deliver cutting-edge care and are a driver for innovation, supporting pioneering clinical practice in the NHS. For more information about specialised services, view the NHS England (NHSE) animation below.


Specialised services are not available in every local hospital because they have to be delivered by specialist teams of doctors, nurses and other health professionals who have the necessary skills and experience. Unlike most healthcare, which is planned and arranged locally, specialised services have been planned nationally and regionally by NHSE.

The delegation of services from NHSE to ICSs is effectively the devolution of services (and their commissioning responsibilities) from NHSE to more local bodies (ICSs). ICSs are partnerships that bring NHS organisations, local authorities and other organisations together to take collective responsibility for planning services, improving health and reducing inequalities across geographical areas. The Integrated Care Board (ICB) is a statutory NHS organisation which is responsible for developing a plan to meet the health needs of the population, managing the NHS budget and arranging the provision of health services in a geographical area.

The new Health and Care Act 2022 gives the NHS the opportunity to reconnect the commissioning of whole pathways of care (from Primary, Community, Secondary and Specialised). As part of the Health and Care Act 2022, NHSE announced that from April 2023, 65 specialised services would be planned and commissioned by Integrated Care Systems (ICSs). A further 27 specialised services were deemed suitable but not yet ready to be delegated to ICSs. In total, specialised services totalling 80% of the specialised services commissioning budget will be transferred from NHSE to ICSs, while 81 specialised services that are not suitable to be transferred to ICSs will continue to be commissioned by NHSE.

On 31 May 2022, NHSE set out plans to delegate the responsibility of specialised commissioning services to the newly established ICSs. This means that many specialised services that have been planned and commissioned at a national level will now be planned and commissioned at either a single ICB, multi ICB, regional or national level. This is referred to as the tiering of services.  For example, where a NCL hospital has high volumes of patient activity from outside of NCL, a multi-ICB arrangement may need to be put in place to ensure collaborative commissioning.

The Roadmap for integrating specialised services within Integrated Care Systems was released on 31 May 2022 and set out the phased transition into integrated services and identified:

  1. Services suitable for delegation
  2. Services suitable for delegation at a later stage.
  3. Services to be retained nationally (i.e. highly specialised services).

North Central London ICB will enter into a Joint Working Agreement with NHSE London Region for 2023/24. The aim of the joint working arrangement for this transitional year is to enable the ICB to work through areas of risk identified through the Pre Delegation Assessment Framework.

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