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Commissioning changes

NHS England is still undergoing significant reorganisation, following the absorption of NHS Improvement, Health Education England and NHS Digital into the NHS England framework.

Some of the main changes involves how funding is allocated and Specialised Commissioning, but it might be best to start with a quick overview (Please note, this piece only reflects the main changes within England and will not cover any changes in Scotland, Wales or Northern Ireland.)


The level of NHS funding each year is set by central government through the Spending Review process. Most of the allocation goes towards commissioning of local health services and ‘directly commissioned’ services including some primary care services, specialised services and public health. The remaining funds are allocated to the delivery of service development and improvement programmes. This is called the Service Development Fund (SDF). 

Previously, there were separate SDF allocations from all the different national programmes, such as Respiratory, Diabetes, Cardiac, Mental Health etc which were then distributed to the NHS England regions and then out to Clinical Commissioning Groups (CCGs). Following the passage of the 2022 Health and care Act, CCGs were abolished and Integrated Care Systems were formalised in their place as legal entities, with an Integrated Care Board taking responsibility (as a statutory body) for planning and funding local services in place of CCGs. This is the latest in many years of evolution towards integrative care.  

Therefore, ICBs now have relative autonomy in allocating the NHS budget and commissioning services for the local population and can delegate them to place based committees however, ICBs are still accountable nationally to NHS England for spending and performance, including expectations to meet national requirements and performance targets.  

Changes to SDF Funding 

A single Programme Bundle is now sent to each ICB with the intention of allowing more strategic, localised and increased targeting towards minimising health inequalities. Therefore, it gives the ICB autonomy over how that money is spent at a local level. For example, although the funding includes distinctly different programmes such as respiratory, cardiac, diabetes and prevention (tobacco, alcohol etc), ICB leadership can choose to move money from one programme to another.  

Specialised Commissioning 

NHS England is accountable for approximately 150 specialised services. In respiratory medicine these include: Severe Asthma (adult), Interstitial Lung Disease (adult), Complex Home Ventilation (adult), Lung Volume Reduction Surgery (adults), Cystic Fibrosis (adults and children), Primary Ciliary Dyskinesia (adult), Lung Transplant (adult), chronic pulmonary aspergillosis services (adult), Lymphanogioleiomyomatosis services (LAM; adults), pulmonary thromboendarterectomy (adults and adolescents) Ataxia telangiectasis service (adults) and Pulmonary Artery Hypertension (adult).  

Following evaluation and assessment, the decision has been made to delegate commissioning responsibility for appropriate specialised services to ICB systems from April 2024. 

The aim of this delegation is to achieve better patient care through focussing funding at a more local level. The ICB know what requirements are needed for local population bring care closer to home.  

For respiratory Severe asthma (adults), Lung Volume Reduction Surgery (adults) and Interstitial Lung Disease (adults) have been identified as suitable for delegation. In addition, Specialist respiratory services for children and Adult Critical Care have been identified as suitable. Please see the full list here. 

East of England, North West and Midlands shall be delegated from 2024/2025. 

North East & Yorkshire, London, South East and South West will be supported for one more year of statutory joint commissioning with a clear expectation that services will be delegated from April 2025. 

Get Involved! 

Find out how you can influence respiratory policy. You can consider things like: 

  • How to become part of your regional Respiratory Network whether this is run by your ICB or by regional NHS England teams.  
  • Who your Respiratory Clinical Leads are. 
  • Joining any other regional or national workstreams for example Pulmonary Rehabilitation, Community Acquired Pneumonia, Critical Care Networks or Severe Asthma Networks etc.