The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012 No. 2996

Regulations 7, 10 and 11

SCHEDULE 4 E+W Services for rare and very rare conditions

Interpretation E+W

1.  For the purposes of this Schedule—

(a) an individual is a child if they have not yet attained the age of 18 years old;

(b) an individual is a young person if they are aged 13 years old or over but have not yet attained the age of 21 years old; and

(c) an individual is an adult if they are aged 18 years old or over,

unless, for the purposes of a service specified in this Schedule, [F1 NHS England], or the person providing such a service pursuant to a commissioning contract with [F1 NHS England], considers on clinical grounds that an individual should otherwise be treated as a child, a young person or an adult.

Textual Amendments

F1 Words in Regulations substituted (6.11.2023) by The Health and Care Act 2022 (Further Consequential Amendments) (No. 2) Regulations 2023 (S.I. 2023/1071), reg. 1(1), Sch. para. 1

The services E+W

2.  Adult ataxia telangiectasia services.

3.  Adult congenital heart disease services. E+W

[F2 3A.   Adult highly specialist oesophageal gastric services in the form of gastro-electrical stimulation for patients with intractable gastroparesis.] E+W

Textual Amendments

F2 Sch. 4 para. 3A inserted (1.4.2015) by The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2015 (S.I. 2015/415), regs. 1(1), 2(3)

4.  Adult highly specialist pain management services. E+W

5.  Adult highly specialist respiratory services. E+W

6.  Adult highly specialist rheumatology services. E+W

7.  Adult secure mental health services. E+W

8.  Adult specialist cardiac services. E+W

9.  Adult specialist eating disorder services. E+W

10.  Adult specialist endocrinology services. E+W

F3 11.  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E+W

Textual Amendments

F3 Sch. 4 para. 11 omitted (1.4.2015) by virtue of The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2015 (S.I. 2015/415), regs. 1(1), 2(4)

12.  Adult specialist neurosciences services. E+W

13.  Adult specialist ophthalmology services. E+W

14.  Adult specialist orthopaedic services. E+W

15.  Adult specialist pulmonary hypertension services. E+W

16.  Adult specialist renal services. E+W

17.  Adult specialist services for patients infected with HIV. E+W

18.  Adult specialist vascular services. E+W

19.  Adult thoracic surgery services. E+W

20.  Alkaptonuria service. E+W

[F4 20A.   Alpha 1 antitrypsin services.] E+W

Textual Amendments

F4 Sch. 4 para. 20A inserted (1.4.2019) by The Responsibilities and Standing Rules, and Care and Support (Miscellaneous Amendments) Regulations 2018 (S.I. 2018/283), regs. 1(3)(b), 2(4)(a)

21.  Alström syndrome service. E+W

22.  Ataxia telangiectasia service for children. E+W

[F5 22A.   Atypical haemolytic uraemic syndrome services.] E+W

Textual Amendments

F5 Sch. 4 para. 22A inserted (1.4.2014) by The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) (No. 2) Regulations 2014 (S.I. 2014/452), regs. 1(1), 3(2)

23.  Autoimmune paediatric gut syndromes service. E+W

24.  Autologous intestinal reconstruction service for adults. E+W

25.  Bardet-Biedl syndrome service. E+W

26.  Barth syndrome service. E+W

27.  Beckwith-Wiedemann syndrome with macroglossia service. E+W

28.  Behcet's syndrome service. E+W

29.  Bladder exstrophy service. E+W

30.  Blood and marrow transplantation services. E+W

[F6 31.   Bone conduction hearing implant services.] E+W

Textual Amendments

F6 Sch. 4 para. 31 substituted (1.4.2015) by The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2015 (S.I. 2015/415), regs. 1(1), 2(5)

32.  Breast radiotherapy injury rehabilitation service. E+W

33.  Child and adolescent mental health services – Tier 4. E+W

34.  Choriocarcinoma service. E+W

35.  Chronic pulmonary aspergillosis service. E+W

36.  Cleft lip and palate services. E+W

[F7 36A.   Clinical genomic services.] E+W

Textual Amendments

F7 Sch. 4 para. 36A inserted (1.4.2018) by The Responsibilities and Standing Rules, and Care and Support (Miscellaneous Amendments) Regulations 2018 (S.I. 2018/283), regs. 1(2), 2(4)(b)

37.  Cochlear implantation services. E+W

38.  Complex childhood osteogenesis imperfecta service. E+W

39.  Complex Ehlers Danlos syndrome service. E+W

40.  Complex neurofibromatosis type 1 service. E+W

41.  Complex spinal surgery services. E+W

42.  Complex tracheal disease service. E+W

43.  Congenital hyperinsulinism service. E+W

44.  Craniofacial service. E+W

45.  Cryopyrin associated periodic syndrome service. E+W

46.  Cystic fibrosis services. E+W

47.  Diagnostic service for amyloidosis. E+W

48.  Diagnostic service for primary ciliary dyskinesia. E+W

49.  Diagnostic service for rare neuromuscular disorders. E+W

50.  Encapsulating peritoneal sclerosis treatment service. E+W

51.  Epidermolysis bullosa service. E+W

52.  Extra corporeal membrane oxygenation service for adults. E+W

53.  Extra corporeal membrane oxygenation service for neonates, infants and children with respiratory failure. E+W

54.  Ex-vivo partial nephrectomy service. E+W

55.  Fetal medicine services. E+W

56.  Gender identity development service for children and adolescents. E+W

57.  Gender identity disorder services. E+W

[F8 57ZA.   Gonadal tissue cryopreservation services for children and young people at high risk of gonadal failure due to treatment or disease.] E+W

Textual Amendments

F8 Sch. 4 para. 57ZA inserted (1.4.2020) by The Responsibilities and Standing Rules, and Care and Support (Miscellaneous Amendments) Regulations 2018 (S.I. 2018/283), regs. 1(3)(c), 2(4)(c)

[F9 57A.   Hand transplantation for adults.] E+W

Textual Amendments

F9 Sch. 4 para. 57A inserted (1.4.2014) by The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) (No. 2) Regulations 2014 (S.I. 2014/452), regs. 1(1), 3(3)

58.  Heart and lung transplantation service [F10 (including mechanical circulatory support)]. E+W

Textual Amendments

F10 Words in Sch. 4 para. 58 substituted (1.4.2016) by The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2016 (S.I. 2016/293), regs. 1(1), 4(2)(a) (with reg. 5)

[F11 59.   Highly specialist adult gynaecological surgery and urinary surgery services for women.] E+W

Textual Amendments

F11 Sch. 4 paras. 59, 59A substituted for Sch. 4 para. 59 (1.4.2015) by The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2015 (S.I. 2015/415), regs. 1(1), 2(6)

[F11 59A.   Highly specialist adult urological surgery services for men.] E+W

Textual Amendments

F11 Sch. 4 paras. 59, 59A substituted for Sch. 4 para. 59 (1.4.2015) by The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2015 (S.I. 2015/415), regs. 1(1), 2(6)

60.  Highly specialist allergy services. E+W

F12 61.  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E+W

Textual Amendments

F12 Sch. 4 para. 61 omitted (1.4.2015) by virtue of The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2015 (S.I. 2015/415), regs. 1(1), 2(7)

62.  Highly specialist dermatology services. E+W

63.  Highly specialist metabolic disorder services. E+W

64.  Highly specialist pain management services for children and young people. E+W

65.  Highly specialist palliative care services for children and young people. E+W

66.  Highly specialist services for adults with infectious diseases. E+W

67.  Hyperbaric oxygen treatment services. E+W

68.  Insulin-resistant diabetes service. E+W

69.  Islet transplantation service. E+W

70.  Liver transplantation service. E+W

71.  Lymphangioleiomyomatosis service. E+W

72.  Lysosomal storage disorder service. E+W

73.  Major trauma services. E+W

74.  McArdle's disease service. E+W

75.  Mental health service for deaf children and adolescents. E+W

[F13 76.   Mitochondrial donation service.] E+W

Textual Amendments

F13 Sch. 4 para. 76 inserted (1.4.2016) by The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2016 (S.I. 2016/293), regs. 1(1), 4(2)(b) (with reg. 5)

77.  Neurofibromatosis type 2 service. E+W

78.  Neuromyelitis optica service. E+W

79.  Neuropsychiatry services. E+W

80.  Ocular oncology service. E+W

81.  Ophthalmic pathology service. E+W

82.  Osteo-odonto-keratoprosthesis service for corneal blindness. E+W

83.  Paediatric and perinatal post mortem services. E+W

84.  Paediatric cardiac services. E+W

85.  Paediatric intestinal pseudo-obstructive disorders service. E+W

86.  Pancreas transplantation service. E+W

87.  Paroxysmal nocturnal haemoglobinuria service. E+W

88.  Positron Emission Tomography – Computed Tomography services. E+W

89.  Primary ciliary dyskinesia management service. E+W

90.  Primary malignant bone tumours service. E+W

91.  Proton beam therapy service. E+W

92.  Pseudomyxoma peritonei service. E+W

[F14 92A.   Psychological medicine inpatient services for severe and complex presentations of medically unexplained physical symptoms.] E+W

Textual Amendments

F14 Sch. 4 para. 92A inserted (1.4.2020) by The Responsibilities and Standing Rules, and Care and Support (Miscellaneous Amendments) Regulations 2018 (S.I. 2018/283), regs. 1(3)(c), 2(4)(d)

93.  Pulmonary hypertension service for children. E+W

94.  Pulmonary thromboendarterectomy service. E+W

95.  Radiotherapy services. E+W

96.  Rare mitochondrial disorders service. E+W

97.  Reconstructive surgery service for adolescents with congenital malformation of the female genital tract. E+W

98.  Retinoblastoma service. E+W

99.  Secure forensic mental health service for young people. E+W

100.  Severe acute porphyria service. E+W

101.  Severe combined immunodeficiency and related disorders service. E+W

102.  Severe intestinal failure service. E+W

103.  Severe obsessive compulsive disorder and body dysmorphic disorder service. E+W

104.  Small bowel transplantation service. E+W

[F15 104A.   Specialist adult haematology services.] E+W

Textual Amendments

F15 Sch. 4 para. 104A inserted (1.4.2020) by The Responsibilities and Standing Rules, and Care and Support (Miscellaneous Amendments) Regulations 2018 (S.I. 2018/283), regs. 1(3)(c), 2(4)(e)

105.  Specialist burn care services. E+W

106.  Specialist cancer services. E+W

107.  Specialist cancer services for children and young people. E+W

[F16 107A.   Specialist colorectal surgery services.] E+W

Textual Amendments

F16 Sch. 4 para. 107A inserted (1.4.2015) by The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2015 (S.I. 2015/415), regs. 1(1), 2(9)

108.  Specialist dentistry services for children and young people. E+W

109.  Specialist ear, nose and throat services for children and young people. E+W

110.  Specialist endocrinology and diabetes services for children and young people. E+W

111.  Specialist gastroenterology, hepatology and nutritional support services for children and young people. E+W

F17 112.  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E+W

Textual Amendments

F17 Sch. 4 para. 112 omitted (1.4.2018) by virtue of The Responsibilities and Standing Rules, and Care and Support (Miscellaneous Amendments) Regulations 2018 (S.I. 2018/283), regs. 1(2), 2(4)(f)

113.  Specialist gynaecology services for children and young people. E+W

114.  Specialist haematology services for children and young people. E+W

115.  Specialist haemoglobinopathy services. E+W

[F18 116.   Specialist immunology services for adults with deficient immune systems.] E+W

Textual Amendments

F18 Sch. 4 paras. 116, 116A substituted for Sch. 4 para. 116 (1.4.2015) by The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2015 (S.I. 2015/415), regs. 1(1), 2(10)

[F18 116A.   Specialist immunology services for children with deficient immune systems.] E+W

Textual Amendments

F18 Sch. 4 paras. 116, 116A substituted for Sch. 4 para. 116 (1.4.2015) by The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2015 (S.I. 2015/415), regs. 1(1), 2(10)

[F19 116B.   Specialist maternity care for women diagnosed with abnormally invasive placenta.] E+W

Textual Amendments

F19 Sch. 4 para. 116B inserted (1.4.2016) by The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2016 (S.I. 2016/293), regs. 1(1), 4(2)(c) (with reg. 5)

117.  Specialist mental health services for deaf adults. E+W

F20 118.  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E+W

Textual Amendments

F20 Sch. 4 para. 118 omitted (1.4.2016) by virtue of The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2016 (S.I. 2016/293), regs. 1(1), 4(2)(d) (with reg. 5)

119.  Specialist neonatal care services. E+W

120.  Specialist neuroscience services for children and young people. E+W

121.  Specialist ophthalmology services for children and young people. E+W

122.  Specialist orthopaedic surgery services for children and young people. E+W

123.  Specialist paediatric intensive care services. E+W

124.  Specialist paediatric liver disease service. E+W

125.  Specialist perinatal mental health services. E+W

126.  Specialist plastic surgery services for children and young people. E+W

127.  Specialist rehabilitation services for patients with highly complex needs. E+W

128.  Specialist renal services for children and young people. E+W

129.  Specialist respiratory services for children and young people. E+W

130.  Specialist rheumatology services for children and young people. E+W

131.  Specialist services for children and young people with infectious diseases. E+W

132.  Specialist services for complex liver, biliary and pancreatic diseases in adults. E+W

133.  Specialist services for haemophilia and other related bleeding disorders. E+W

134.  Specialist services for severe personality disorder in adults. E+W

135.  Specialist services to support patients with complex physical disabilities [F21 excluding wheelchair services]. E+W

Textual Amendments

F21 Words in Sch. 4 para. 135 inserted (1.4.2015) by The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2015 (S.I. 2015/415), regs. 1(1), 2(11)

136.  Specialist surgery for children and young people. E+W

137.  Specialist urology services for children and young people. E+W

138.  Spinal cord injury services. E+W

139.  Stem cell transplantation service for juvenile idiopathic arthritis and related connective tissue disorders. E+W

140.  Stickler syndrome diagnostic service. E+W

[F22 140A.   Surgery for complex obesity in children.] E+W

Textual Amendments

F22 Sch. 4 para. 140A inserted (1.4.2016) by The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2016 (S.I. 2016/293), regs. 1(1), 4(2)(e) (with reg. 5)

[F23 140AA.   Termination services for expectant mothers with significant comorbidities that require either or both critical care and medical support.] E+W

Textual Amendments

F23 Sch. 4 para. 140AA inserted (1.4.2018) by The Responsibilities and Standing Rules, and Care and Support (Miscellaneous Amendments) Regulations 2018 (S.I. 2018/283), regs. 1(2), 2(4)(g)

[F24 140B.   Uterine transplantation services.] E+W

Textual Amendments

F24 Sch. 4 para. 140B inserted (1.4.2017) by The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2017 (S.I. 2017/296), regs. 1, 2(2)

141.  Vein of Galen malformation service. E+W

142.  Veterans' post traumatic stress disorder programme. E+W

143.  Wolfram syndrome service. E+W

144.  Xeroderma pigmentosum service. E+W