As a Welsh Clinical Leadership Fellow working within Welsh Health Specialised Services Committee (WHSSC) I have gained a new perspective on the Welsh NHS. WHSSC is responsible for commissioning specialist services in Wales and offers a wide arena in which to develop leadership skills. My fellowship has given me an invaluable insight into the way NHS specialist services are planned, prioritised and funded across Wales.

Specialist commissioning utilises an ongoing cycle of evaluation ensuring services bring value to patient’s and the system. My project was to assess the potential for developing a specialist service for Pulmonary Hypertension (PH) within Wales, currently provided by NHSE. Drawing upon commissioning theory, quality improvement models and a value based healthcare approach, the work has assessed potential interventions that could be made in the commissioning strategy of this service in Wales. I have developed a new clinical network comprising clinicians in Wales and England involving multiple site visits and establishing a Welsh clinical working group. This project stream has run concurrently with mapping work against the commissioning governance structure.

A collaborative approach has been required to lead this project. Redeveloping an existing commissioning arrangement is complex and involves engaging with multiple stakeholders. Adopting an open and honest approach with regards to the intention of this project has been paramount. Certainly, any future Welsh PH service would be established with significant support from an NHSE provider therefore maintaining an excellent relationship with these external centres has been vital.

The project has provided significant challenges with regards to data access and engaging certain stakeholder groups. At the end of this year I have identified a range of service options and established a clinical network. This provides a strong basis on which the commissioning team can take forward an option appraisal process.