Keep it together - don't fragment spinal cord injury services

NHS England has indicated that commissioning responsibility for adult and paediatric spinal cord injury services may transfer from national specialised commissioning to Integrated Care Boards from April 2027. 

Spinal cord injury services are currently commissioned nationally because they are highly specialised, serve relatively small patient populations, and require nationally coordinated referral pathways and clinical expertise. 

There are significant concerns across the spinal cord injury sector that transferring commissioning responsibility to 36 Integrated Care Boards risks increasing fragmentation within a pathway that is already under strain. 

The recent APPG on Spinal Cord Injury Inquiry found that the current SCI pathway already suffers from fragmentation, variation in access to rehabilitation, and inconsistent access to long-term support and community reintegration. 

Specialist Spinal Cord Injury Centres also face longstanding pressures, including limited bed capacity, ageing infrastructure, and years of underinvestment. 

 

The facts 

Spinal cord injury care requires national coordination. Fragmenting commissioning risks worsening inequalities, undermining specialist centres, and harming patient outcomes. 

• Spinal cord injury is a low-volume, high-complexity condition that requires nationally coordinated specialist care.
• Specialist Spinal Cord Injury Centres serve patients from across England and depend on nationally coordinated referral pathways, specialist workforce expertise, and stable funding arrangements.
• The APPG Inquiry into spinal cord injury services found that the current pathway is already fragmented, with variation in access to rehabilitation and long-term support.
• Transferring commissioning responsibility to 36 Integrated Care Boards risks entrenching postcode variation in access to care.
• SCI centres already operate with limited bed capacity and ageing infrastructure following years of underinvestment.
  Further fragmentation risks undermining the sustainability of these nationally significant specialist services and may even lead to closure of SCI centres.
• National coordination is essential to ensure consistent access to specialist rehabilitation, multidisciplinary care, and long-term support for people living with spinal cord injury.
• The sector supports improvements to services and patient outcomes, but believes that highly specialised services such as spinal cord injury care should remain nationally commissioned.

Map: NHS regions with current spinal cord injury centres

Potential Risks if Commissioning Is Decentralised

• Specialist Spinal Cord Injury Centres could face increased financial uncertainty and even closure, if highly specialised SCI services are deprioritised within local commissioning systems.
• Patients could experience greater postcode variation in access to specialist rehabilitation and long-term care.
• Delays in accessing specialist rehabilitation could increase the risk of complications and reduce long-term independence for people living with spinal cord injury.
• National referral pathways that currently ensure at least a certain percentage of patients reach specialist centres quickly could become weaker or less consistent.
• Over time, fragmentation of commissioning could undermine the viability of some specialist services, including a drastic reduction in specialist staff, if patient volumes and funding streams become uncertain.

 

How can you help

We are asking that those within the SCI community support us by contacting your local MP, voicing your concern about the proposals and protect national coordination of spinal cord injury services.

To write to your local member of parliament:

1. Find your local MP’s name and email.
2. Download our letter template.
3. Put in your MP’s name, add your own contact details and the date.
4. Change the red text, and add any information about your experiences.
5. Save and send to your MP.

download the letter template (.doc) FIND YOUR MP CONTACT DETAILS