Information for Commissioners

Commissioning your Specialist Neuro-Rehabilitation Service

What are Specialist Neuro-Rehabilitation Services?

Rehabilitation can be defined as a process of assessment, treatment and management by which the individual (and their family / carers) are supported to achieve their maximum potential for physical, cognitive, social and psychological function, participation in society and quality of living .Specialist rehabilitation is the total active care of patients with a disabling condition, and their families, by a multi-professional team who have undergone recognised specialist training in rehabilitation, led / supported by a consultant trained and accredited in rehabilitation medicine or neuropsychiatry.

Specialist Rehabilitation Services are defined by the NHSE service specification D02, ie  D02 Service Specification for Specialist rehabilitation patients with highly complex needs . There are three broad levels of complexity of services, with level 1 (L1) being the most complex, planned over a larger regional footprint of 1-3 million. Integrated Care Boards (ICBs) were delegated the commissioning of specialist rehabilitation services from 1/4/2025, whilst NHSE retains oversight of the national standard and national D02 service provision requirements.

What are RAAR Services?

Across London there have historically been long waiting lists for patients requiring access to specialist neurorehabilitation services. To help address some of the issues, £5 million funding was allocated in FY 2022/23 to deliver four Rapid Access Acute Rehabilitation (RAAR) services across London aligned to the four London trusts who are both a Major Trauma Centre (MTC) and a Neurosciences Centre, totalling 32 physical or virtual beds across London region (eight per Trust). The scope of the project was to provide and deliver rapid access acute beds with short length of stay (LOS) and high-level clinical input for patients with Category A or B needs, to facilitate discharge home with / without an appropriate package of care, or discharge to a suitable placement (such as L1 or L2 service, or specialist care home). The main aims were to:

1. Reduce delays into Specialised Rehabilitation Units (SRUs) which impact upon acute trusts

2. Reduce overall LOS for patients

3. Ensure patients receive care earlier in their pathway to support better outcomes

There will be an evaluation report when sufficient data has been captured to monitor the longer-term outcomes as set out at the initiation of the project.

NHS Payment Scheme

Between 2013 and 2024

• Level 1 and 2a services have been commissioned centrally by NHS England under the D02 Service Specification for Specialist rehabilitation patients with highly complex needs

• Level 2b services were commissioned by their local Clinical Commissioning Group (CCG)

• For list of Level 1 and 2 services in England, please click here

From April 2025 onwards:

• Commissioning of specialist rehabilitation is to be delegated to ICBs

• NHS England remains responsible for the service specification and for ensuring that patients with complex needs receive the specialised services they require

• Over time, service specifications are likely to become more outcomes-focused

Specialist Rehabilitation Commissioning presentation (2023)

Mandated Commissioning Currency - WBD

NHSE has implemented a multi-level mandated weighted bed day (WBD) commissioning currency for specialist rehabilitation services along with guide prices:

• The consultation NHS PS 2025/26 was published on 30th January 2025. Annex DpA - NHS Payment Scheme prices workbook contains the proposed 2025/26 NHSPS unit and guide prices and related information

• The WBD commissioning currency is operationalised through the UK ROC dataset

• The currency is the weighted bed day (WBD) – based on a 5-tier structure, in which a set of five weighting factors are applied to the standard per diem rate

• For simplicity, the multi-level WBD currency is expressed in terms of a single WBD figure for activity with a single WBD costs

For further information on the above, please read this brief Commissioning pdf

How to calculate the WBD currency

UK ROC has developed a basic Tariff Calculator using Excel that allows for the easy conversion of Occupied Bed Days (OBD's) into the mandated currency of Weighted Bed Days (WBD's).

Please feel free to use the Tariff Calculator (2025/26) or contact UK ROC (LNWH-tr.ukroc@nhs.net) for help (eg to ask for the complexity profile of the Service, etc).

UK ROC ICB Service reports

UK ROC has compiled introductory regional reports for ICBs outlining their Specialist Neuro Rehabilitation Services. We hope that these documents will be useful as ICBs plan for the provision of these services both regionally and nationally. These reports contain only a small subset of the information within UK ROC. Please do contact UK ROC (LNWH-tr.ukroc@nhs.net) for further information if required.