South London
Pathfinder programme

Paving the way for specialised services delegation to ICBs from April 2024

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Playbook: Lessons learned

We are delighted to share the Pathfinder playbook, which incorporates lessons learned and recommendations arising from the implementation of Pathfinder, plus resources to support systems in local adoption of some of the recommendations.

  • Phase 1 – lessons learned and recommendations arising from the preparation for Pathfinder
  • Phase 2 – lessons learned and recommendations arising from the implementation of Pathfinder and some resources to support systems in local adoption of some of the recommendations

Overview

The South London Pathfinder programme provides an opportunity to test key processes and gather intelligence to inform delegation of specialised services from NHS England to integrated care systems (ICSs) in 2024/25.

The lessons from the programme will be shared across all regions to help support delegation across the seven regions in 2024/25.

Purpose

The purpose of the South London Pathfinder programme will be to test the delegation processes and national products during 23/24 in a safe and managed way to support the design of the delegation model for 24/25. The focus will be on finance, BI and contracting.

Details

Further detail / documents of the South London Pathfinder programme is available on FutureNHS, within the Specialised Services Future Commissioning Model workspace (login required). 

Pathfinder overview: Scope, services, and arrangements

Scope

There are three key areas within the programme:

The intention of Pathfinder is to undertake select elements of specialised services delegation to test the functionality of transactional payment and reporting elements only.

Pathfinder is not full delegation. NHS England continues to remain the commissioner of specialised services and as such retains financial liability.

 

Governance

The South London Pathfinder programme is overseen by its Programme Board.

View the Programme Board terms of reference. Further papers are available on the FutureNHS platform (login required).

FAQs

Browse our frequently asked questions (FAQs).

Enquiries

If you would like to know more about the South London Pathfinder programme, or would like for the team to present to your colleagues, please contact Jen Gospel, Programme Manager.

Background

The four minute video at right describes specialised services, the rationale for delegation, the role of the Pathfinder programme.

Timeline

  • The Roadmap for integrating specialised services (May 2022) within integrated care systems, set an expectation that integrated care boards (ICBs) would take on greater commissioning responsibility for ‘suitable and ready’ specialised services from April 2023.
  • The ambition was for ICBs to take on delegated commissioning arrangements, subject to a system readiness assessment process. There was always a ‘back-stop’ of establishing formal joint working arrangements between ICBs and NHS England through statutory joint committees should full delegation not prove possible.
  • It became clear in late 2022 that ICBs across the country would be establishing joint working arrangements with NHS England from April 2023, rather than taking on delegated commissioning arrangements, due to several reasons including:
    • ICBs being new organisations still establishing themselves in their own right
    • Limited capacity and capability to take on new commissioning responsibilities in April 23
    • Other system-wide challenges and resulting prioritisation of resource.

The preference became a ‘stepping together’ model – where all ICBs across the country establish formal joint working arrangements with NHS England for 23/24, with a view to stepping together again in 24/25 and all ICBs taking on delegated commissioning responsibility. This requires ICBs to identify the right multi-ICB footprints for specific services through 23/24.

  • NHSE specialised commissioning recognise that there are risks in £20Bn of specialised spend ‘stepping together’ from NHSE to ICBs without any testing. The South London pathfinder programme is a response to these risks.
  • There are flexibilities that exist within a joint working arrangement with NHS England to flex the role of ICBs to take on greater responsibility for finance, business intelligence (BI) and contracting transactional change. Therefore, this is an opportunity for NHS England to work with South London ICBs to test elements of the delegated model during 23/24 in a safe and managed way to support the design and implementation from 24/25.