News / NHS finance 'reset' with seven-point plan

The package of measures aims to deliver an aggregate provider sector deficit of £250m by year-end, with the ambition that it begins 2017/18 in aggregate run rate balance. The seven-point plan includes:

• The £1.8bn sustainability and transformation funds have been allocated
• National fines will be replaced by trust-specific incentives linked to their improvement trajectories. This should ‘kick start’ recovery of A&E and elective care over a number of years
• Every trust and clinical commissioning group has agreed financial control totals and their boards, chief executives and governing bodies will be held accountable for delivering these targets
• There is a new intervention regime for trusts and CCGs not meeting their financial targets, with five providers and nine CCGs immediately entering special measures
• New controls to cap the cost of interim managers in CCGs and commissioning support units and to speed up savings in back office, pathology and temporary staffing in providers
• CCG performance ratings for 2015/16 have been published
• There will be a two-year planning and contracting round (2017/18 and 2018/19), which will be completed by December this year and linked to sustainability and transformation plans

 

In addition, NHS Improvement has asked providers to work specifically on three areas: managing excessive pay bill growth; accelerating implementation of the Carter recommendations on back office services; and consolidating unsustainable planned care.

The first five providers to enter financial special measures are confirmed as:

 

·        Barts Health NHS Trust

·        Croydon Health Services NHS Trust

·        Maidstone and Tunbridge Wells NHS Trust

·        Norfolk and Norwich University Hospitals NHS Foundation Trust

·        North Bristol NHS Trust.

 

NHS England published CCG ratings, with 10 rated outstanding, 82 good and 91 requiring improvement. It will take action on the 26 CCGs rated inadequate and immediately placed nine CCGs in special measures. They are:

• Coventry and Rugby CCG
• Croydon CCG (based on its financial position in quarter one of 2016/17 – the CCG was rated as ‘requires improvement and not ‘inadequate’ in 2015/16)
• East Surrey CCG
• Enfield CCG
• North Somerset CCG
• North Tyneside CCG
• South Gloucestershire CCG
• Vale of York CCG
• Walsall CCG.

 

NHS England said that from today CCGs will be rated under a new approach, based on 29 areas with 60 indicators – 41 of the indicators were due to be published today and the new areas include six clinical priorities (cancer, dementia, diabetes, learning disabilities, maternity and mental health), which match those set out in the Five-year forward view.  

Simon Stevens (pictured), NHS England chief executive, said most trusts and CCGs knew what had to be done and it was now time to ‘fire the starting gun’.

He added: ‘Today's “reset” sets out the agreed legal responsibilities of individual NHS bodies to live within the funding Parliament has decided should be available to the NHS this year. These individual accountabilities will be supplemented by the sustainability and transformation plans now being developed in communities across England, which will set out the wider, shared action they will take together to unleash broader improvement on health, care, and financial sustainability to 2020.’

NHS Improvement chief executive Jim Mackey said: ‘This suite of measures will help ensure that the providers facing the greatest financial challenges are supported to bring about rapid financial recovery, while maintaining or improving quality. This plan is intended to restore financial discipline and ensure ongoing financial sustainability across the whole NHS.’

Saffron Cordery, director of policy at NHS Providers, said the announcement was a welcome acknowledgement of the scale of the financial challenge. As the problem was structural and system-wide, all parts of the health and social care system had to come together to restore financial balance and put the service on a sustainable footing.

‘Today’s announcement outlines a plan to try and stabilise finances in the immediate term. But we need a revised approach to financial planning in the long term and a much smaller set of priorities on which the NHS ruthlessly focuses in the short term, with everything else taking second place. Without these we cannot even begin to tackle the likely consequences of the middle years of this parliament when available funding reduces dramatically,’ she added.

NHS Confederation chief executive Stephen Dalton said: ‘We recognise the importance of financial rigour, however it should be recognised that the service has already made unprecedented savings in hugely challenging circumstances. The uncertainty following the Brexit vote is likely to compound financial concerns.

‘Now is an important time for the government and national bodies to assure NHS leaders that a focus on stability does not come at the expense of transformation. This is critical to improve care for patients at a local level and will ultimately deliver sustainability for the future.’