Productivity improvements prioritised in 2023/24 planning guidance

The guidance, published just before Christmas, also calls for progress in delivering the key ambitions in the NHS long-term plan and continued transformation of the NHS for the future. (The HFMA has produced a summary of the planning guidance.)

Overall, the number of national targets has been significantly reduced. Specific requirements include improvement in accident and emergency waiting times, with no less than 76% of patients seen within four hours by the end of the year, and ambulance response times for category 2 calls improving to an average of 30 minutes. The guidance also calls for adult general and acute bed occupancy to be no more than 92% to improve patient flow.

On elective care, waits of over 65 weeks must be eliminated by the end of the year. And for cancer services, the guidance calls for the faster diagnosis standard to be delivered, a reduction in the number of patients waiting over 62 days and an increase in the number of cancers diagnosed at stage 1 and 2.

Community services have been asked to meet or exceed the 70% two-hour urgent community response standard and to improve direct access arrangements to reduce unnecessary GP appointments. And for mental health, there are targets to improve access to support for children and young people and to achieve a 5% year-on-year increase in the number of adults supported by community mental health services.

The autumn statement provided an additional £3.3bn for the NHS in both 2023/24 and 2024/25 and integrated care boards will receive two-year revenue allocations to help with longer term planning. Elective recovery and Covid-19 funding are being rolled into these allocations on a fair share basis. Capital allocations have been topped up by £300m, with funding prioritised for systems that deliver agreed budgets in 2022/23. Most planned care will be paid for at unit prices in what has been seen as a partial return to payment by results.

NHS England said that the NHS would need to meet the 2.2% efficiency target agreed with the government and improve levels of productivity to deliver the required balanced position. Integrated care boards and providers have been asked to get a better understanding of where productivity has been lost and to take steps to restore former productivity. Systems should review workforce growth by staff group and identify expected productivity increases with the growth seen. There are also calls for specific improvements in theatre productivity.

A reduction in agency spending to just 3.7% of the paybill is also being targeted alongside a reduction in corporate running costs by consolidating, standardising and automating services to deliver services at scale across system footprints. A corporate services toolkit, published last year by NHS England, identified 17 opportunities to improve finance functions or deliver savings.

Systems have also been tasked with reducing procurement costs and improving inventory management, with national funding available for providers that do not have effective inventory management systems.

Matthew Taylor, chief executive of the NHS Confederation, said that 2023 would be one of the most challenging years the NHS has ever faced, with the service facing unprecedented pressure. He welcomed the reduction in national targets but warned that continued industrial action would inhibit systems’ ability to achieve them.

‘Much of our success in 2023 will hinge on delivering improvements in patient flow,’ he said. ‘The bed occupancy and discharge targets are challenging and will require local NHS and care services to work hand in glove to improve discharge capacity and processes, as well as investing in hospital avoidance schemes. But the blunt reality is that if social care markets continue to collapse in the way they have been, then some of the key targets outlined in the guidance won’t be achievable.’

He added that the guidance was right to target a reduction in agency spend, but warned that NHS leaders could not ‘magic up new staff’ and would continue to rely on temporary staff until the government published its workforce strategy.

Saffron Cordery (pictured above), interim chief executive at NHS Providers welcomed the recognition that bed occupancy rates were very high. ‘[But] it is clear much more needs to be done nationally to increase capacity across the health and care system if real progress is to be made in achieving this target alongside efforts to reduce delayed discharges,’ she said. 

She also highlighted the significant workforce constraints facing provider organisations and said that trusts should not be punished for ‘constraints outside of their control’.

HFMA summary of 2023/4 priorities and operational planning guidance