Delegating specialised service commissioning: will the latest changes establish an effective structure in England?

The history of specialised commissioning in England over the last 40 years has identified several issues that the NHS has attempted, on many occasions, to address. This article aims to place the most recent reforms within their wider historical context; the reforms issued following the Health and Care Act 2022 are just one more approach organising the commissioning of specialised services. Previous reforms will be examined, up to the most substantial changes introduced by the Health and Social Care Act 2012. In 2012, the commissioning of specialised services was one of several commissioning areas centralised within NHS England, but old problems continued and adverse impacts on service delivery and funding emerged. The latest reforms attempt to address both historical issues and those that have emerged since 2012. Whether this new system is likely to succeed in delivering an effective commissioning structure where previous ones have failed is discussed.