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Specialist services UK

Published on 07 February 2024

We fund services provided in NHS England through two distinct streams:

  • a contribution to NHS England for Scottish patient access to highly specialised services provided on a UK basis. Access is ensured through a service agreement. The report from the NHS England Highly Specialised Commissioning Team (HSCT) details summaries on all the services in the portfolio. Read the latest Highly Specialised Services Highlight Report on the NHS England website.
  • by managing a pool of funds (financial risk share scheme) on behalf of NHS boards to pay for individual patient referrals to specialist services in NHS England. These services are not covered within the agreement outlined above.

We don't track clinical performance of services in England directly. Instead, we work with colleagues in NHS England who are responsible for ensuring the quality of these services.

How do cross border referrals (out of area treatment) work?

We meet the costs of specialist patient treatment outside of Scotland – on behalf of NHS boards – from pooled funds. There is no further budget for funding this care.

Decisions about treatment for any patient referred to a service outside Scotland are made by relevant specialists and the patient's local NHS board. Referral should depend on assessment of clinical need for the individual patient and must come from the 'Out of Area / Safe Haven' team. That team sits within a patient's local NHS board.

Any request for funding must show that the referral is to access a proven, evidence-based specialist intervention that is not available elsewhere in NHSScotland. Normally, it's already commissioned as a specialist service by NHS England.

We authorise funding of treatment if:

  • the referral is from a specialist (usually a consultant) in NHSScotland, with endorsement from a relevant multidisciplinary team if this exists
  • the treatment is specialised and included within the UK Prescribed List of specialised services
  • provision of treatment comes from within the NHS (not private) in England (not abroad)
  • the service is not provided elsewhere in NHSScotland

Funding decisions are made on an individual referral basis by a virtual panel within our National Services Division (NSD). The panel includes the Medical Director, National Medical Advisers and Nursing and Quality Adviser.

Referring clinicians in NHSScotland maintain ongoing clinical contact with the patient and the specialist centre. This ensures that any care that can be offered in Scotland, either by repatriation of the patient or under a shared care arrangement, is provided.

In very rare circumstances, consideration will be given to funding referral to a highly specialised care provider in an internationally recognised unit overseas.