Monitoring access to nationally commissioned services in England
For over 20 years, the National Health Service in England has run a system of national planning for highly specialised healthcare services. The aim is to ensure that very rare diseases are treated, and very complex procedures performed, in only a few centres, each of which maintains a volume high enough to maintain excellent outcomes. The commissioning strategy for the provision of these national services in England is strongly centralising. Centralising does however create a duty to ensure that patients distant from the treatment centres are not thereby disadvantaged. The commissioning process ensures sufficient capacity to treat the entire national caseload of clinically eligible patients. The aim of this paper is to apply the Systematic Component of Variation (SCV) to study access to services commissioned by the National Specialised Commissioning Team (NSCT) in England. The discussion focuses on the potential explanations for a high level of systematic variation between areas and on the use of the SCV to support the monitoring and development of these nationally commissioned services.
Data from nationally commissioned services for the year ending 2011 were received from treating hospital. Mid year age and sex appropriate population estimates were then obtained to provide denominator data. Data were analysed at the geographic level of strategic health authority.
30 services met all requirements for analysis. There is no apparent relationship between SCV and number of locations from which the service is provided. On inspection high SCV is more common among recently commissioned services.
The importance of the SCV lies in its ability to support the development of highly specialised services. Once the random variation has been accounted for, the reasons for a systematic component can be explored. While no absolute cut- off exists, the SCV can be used to gauge and explore services that are potentially not covering the national caseload. The reason for a high SCV may not be immediately apparent; thus the SCV can aid those responsible for commissioning the service to seek potential explanations and identify improvements.
We have reviewed spatial variation in access to a set of highly specialised services in England. On inspecting our results, we believe that they suggest that equity of access can usually be achieved at about five years after establishing a service, and this is not dependent, within the geography of England, on the number of centres designated.
- Kenny TD, Jessop EG, Gutteridge WH: Monitoring clinical quality in rare disease services--experience in England. Orphanet J Rare Dis 2008, 3:23. CrossRef
- Twigger JP, Jessop EG: Small area variation in hospital admission: random or systematic? Public Health 2000,114(5):328–329.
- McPherson K, Wennberg JE, Hovind OB, Clifford P: Small area variations in the use of common surgical procedures: an international comparison of New England, England and Norway. N Engl J Med 1982, 307:1310–1314. CrossRef
- Newton JN, Seagroatt V, Goldacre M: Geographical variation in hospital admission rates: an analysis of workload in the Oxford region, England. J Epidemiol Community Health 1994, 48:590–595. CrossRef
- Ibáñez B, Librero J, Bernal-Delgado E, Peiró S, López-Valcarcel BG, Martínez N, Aizpuru F: Is there too much variation in variation? Revisiting statistics of small area variation in health services research. BMC Health Serv Res 2009, 9:60. http://www.biomedcentral.com/1472–6963/9/60 CrossRef
- Office of National Statisticswww.ons.gov accessed 2011
- Korf BR, Rubenstein AE: Neurofibromatosis: a handbook for patients, families, and health care professionals (2nd edn). 2005. Thieme Medical Publishers ISBN 978-1-58890-301-3
- Monitoring access to nationally commissioned services in England
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
Orphanet Journal of Rare Diseases
- Online Date
- October 2012
- Online ISSN
- BioMed Central
- Additional Links
- Specialised services
- Systematic component of variation
- National case load