The South West Specialised Commissioning Group (SCG) is one of 10 such groups established across England. The SCG is coterminous with NHS South West which covers over 350 kilometers and over 5 million people. The SCG works on behalf of 14 Primary Care Trusts which serve people living in the South West in Cornwall, Devon, Somerset, Bristol, Bath, and Gloucestershire as well as Dorset, including Bournemouth and Poole, Wiltshire and Swindon.
Through a dedicated multi-disciplinary team based in Bristol, Exeter and soon in Salisbury, the SCG plans, commissions and procures services that have been defined as specialized. This work involves needs assessment, strategic planning, often working across boundaries with partners in South Central England and Wales, formal designation of providers through competitive tendering processes, service redesign, performance monitoring and management of both NHS and independent sector providers.
Our aims
- Ensure access as required, to specialised services delivering the highest possible quality, care and treatment standards, clinical and patient reported outcomes, for people living in the South West.
- Ensure best use of scarce resources and achieve best value for money by avoiding wasteful and potentially dangerous duplication of services and ensuring the South West is served by the most cost effective and efficient service providers.
- Contribute to coherent and cohesive strategic planning for all specialist and specialised tertiary services within the South West of England.
- Contribute to the achievement of World Class Commissioning.
What are specialised services?
Specialised services involve complex treatments or packages of care, often for relatively rare conditions. The services may involve the use of very specialised technology and equipment or drugs delivered by a specialist workforce, expert in that area. Some, but not all, of the services are high cost.
These characteristics lead to the need for specialised services to be planned and commissioned using populations of at least 1 million, which is larger than most PCTs, with many of the rarer conditions needing much larger planning populations than this. Consequently, the services are not provided in every hospital and tend to be found only in larger ones which perhaps provide a range of specialised services.
The Department of Health's Specialised Services National Definitions Set (SSNDS) attempts to define these specialised services in more detail. At present there are 35 definitions (of 40 illness/service categories) that cover over 100 services. The definitions are currently being reviewed and updated.
Our commissioning plans
Currently the SCG commissions about £140 million of specialized services across 14 service areas. From 2009-10 we will be commissioning the majority of specialized services in the South West which will increase the level of commissioning to well over £400 million. Key areas of our commissioning include:
- Mental health and learning disability, where we already commission high and medium secure services and from 2009-10 will commission all secure services and complete a procurement exercise that will incorporate all independent sector placements, bringing the value of service up to £100 million.
- Specialised services for children, also £100 million, where we are soon to establish a Paediatric Surgery Network, continue detailed work on neonatal services through our Network and implement a Service Development Strategy for Neuromuscular Services with a value of £1 million over two years.
- Neurosciences, a fast moving area of technology, where our plans for 2009-10 include a strategic review of neuro-rehabilitation services in order to establish a best practice model of care and service across the South West. The value of Neurosciences is around £41 million.
- Designation of service providers to ensure that they meet national designation standards and that service configuration within the South West offers the best services possible for people in the South West. Each designation process is different with some requiring significant change including a competitive tendering process and others focusing more on strengthening the services already in place.
- We will also be undertaking a Strategic Needs Assessment to inform longer term planning and prioritization in next years Operational Plan and developing our patient and public engagement further during 2009-10.
The South West of England
The rural nature of the South West is reflected by the lowest population density in England where four-fifths of the land area in the region is classified as agricultural. There is high car use and ownership and low usage of public transport. There are relatively large distances between major centres and a dispersed population pattern.
The population of the South West comprises five million people living in two million households with a population that is increasing due to inward migration. Single people account for 30% of households and the region has the highest number of second homes. 21% of people are aged over 65 years, which is the highest proportion in England. The proportion of people over 65 years is expected to increase to 23% of the total population by 2021. There are about 7,000 prisoners in 14 prisons across the region.
Approximately 147, 000 residents living in wards ranked in the 10% most deprived nationally. 22% of the population have poor literacy skills and 23% poor numeracy, although the results for young people with GCSE and A levels are better than the national average.
Health of people in the South West
The South West has the highest life expectancy of all the English regions for both women (82.0 years) and men (77.8 years). The comparable figures for England are 80.9 years for women and 76.6 years for men.
The main causes of death in the South West are circulatory disease, cancer and accidnts.
Deaths from all cancers account for approximately 27% if deaths in the South West. However, the mortality rate for all cancers in the South West is lower than that of England as a whole.
In the South West the infant death rate has dropped from 10.4 deaths per 1,000 live births in 1981 to 4.5 in 2005. However, as in other parts of the country, there are higher rates amongst the least affluent in the South West.
Although the South West enjoys relatively good health in relation to the rest of the country there is significant variation between social classes and geographical areas. The map below outlines the Index of Multiple Deprivation 2007.
Men in Gloucester, Bristol and Plymouth have a life expectancy of less than 76 years, which is lower than for men in England as a whole. Women in Swindon, Penwith, Bristol, Gloucester and Plymouth have a life expectancy below the average for England. However, East Dorset has almost the highest life expectancy in the country for both men (80.8 years) and women (83.9 years). Within each geographical area there is a gap between the life expectancy of the most and least affluent wards.
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