New NHS planning guidance for England: Refreshing NHS plans for 2018/19
Context:
The additional NHS funding of £1.6 billion announced in the November 2017 budget and a further £540 million released by the Department of Health & Social Care is being allocated.
As part of the allocation, commissioners and providers are required to update their operational plans for 2018/19 in line with the guidance issued. This is seen as a ‘refresh’ of plans already prepared. Deadline: 23rd March 2018.
Local systems are expected to continue to implement the priority efficiency programmes including Getting It Right First Time recommendations; participation in networked arrangements for procurement, corporate services and diagnostic services; achieving best practice in clinical and other workforce productivity standards; and improving providers’ estate and facilities. The use of RightCare, elective care redesign, urgent and emergency care reform, medicines optimisation, and more integrated primary and community services are also key areas of focus.
Specialised commissioners and providers will also need to review the 2018/19 activity plans. Locally priced services reform, multi-year medicines optimisation approaches (CQUIN), and further reforms to the medical device supply chain, will continue.
Strategic direction
‘Integrated Care Systems’ (ICSs) is the new term for both devolved health and care systems and for those areas previously designated as ‘shadow accountable care systems’. These are seen as key to sustainable improvements in health and care and are required to prepare a single system operating plan.
NHS England recognise that current funding arrangements are an obstacle to the development of ICSs and outline a plan which allows systems to take collective responsibility for financial performance and retain the ability to receive payments from the Sustainability and Transformation Fund (STF).
Over time ICSs will replace STPs and new applications from STPs who can demonstrate their ability to take collective responsibility for financial and operational performance and health outcomes will be reviewed in March 2018.
Choices about money
Where the activity, cost and efficiency assumptions made by an STP do not enable its organisations to meet the control total, the STP will need to agree additional cost containment measures and highlight potential impacts on the range or level of services to be provided.
The resources available to CCGs will be increased by £1.4 billion, principally to fund planned levels of emergency care, the additional elective activity necessary to tackle waiting lists, adherence to the Mental Health Investment Standard and transformation commitments for cancer services and primary care. This will come from:
The requirement for CCGs to underspend 0.5% of their allocations and to use 0.5% of their budget solely for non-recurrent purposes has been lifted.
Some of the money will be allocated to a new Commissioner Sustainability Fund (CSF). Full details to be be published shortly.
More money will be added to the £1.8 billion STF.
An extra £354 million of public capital is being made available as the Government’s commitment to delivering its share of the NHS property and estates investment recommended in the Naylor review. The approval of additional STP capital will be contingent on the STP setting out how the individual organisations in the STP will work together to deploy capital funding to support integrated service models, maximise the sharing of assets and dispose of unused estate.
The National Tariff Payment System will remain in place for next year, but local systems are encouraged to consider local payment reform – in particular, to complement the introduction of ‘advice and guidance’ services.
The next round of interventions eligible for direct reimbursement through the Innovation and Technology Payments, a programme designed to incentivise take-up of the latest innovations across the NHS, will be published by 31 March 2018.
CCGs are asked to consider how to locally implement guidance on the 18 ineffective and low clinical value medicines. It is assumed that all CCGs continue to work to increase standardisation of processes and adopt best practice.
Choices about performance indicators
There is recognition that NHS Constitution targets will not be met in the short-term: A&E waiting targets will not achieve the 95% standard until after March 2019; Numbers of patients waiting more than 52 weeks for treatment should be halved by March 2019.
CCGs will be expected to plan against financial control totals to be communicated ‘shortly’.
Providers who accept their control totals will continue to be exempt from a range of contractual performance sanctions, as set out in the existing NHS Standard Contract. NHS England will shortly consult on changes to the Contract to extend this exemption apart from those relating to mixed sex accommodation, cancelled operations, Healthcare Associated Infections and the duty of candour.
Providers and commissioners are to work together to focus on reducing length of stay.
Systems will be expected to plan and report separately on day case and inpatient elective activity.
Choices about incentives
The new CSF will have a budget of £400 million to incentivise CCGs to deliver against their financial control totals.
£650 million will be added to the £1.8 billion Sustainability and Transformation Fund to create an enhanced £2.45 billion Provider Sustainability Fund. Full details will be published separately but hitting A&E targets and delivering control targets will be key.
NHS England will shortly be publishing an update to the 2017/19 CQUIN guidance. This will include:
Suspending the ‘proactive and safe discharge’ indicator for acute providers and providing an updated indicator for Care Home providers – either a local CQUIN indicator or an increase the weights of the other five indicators.
Withdrawing the 0.5% risk reserve CQUIN and adding it to the engagement CQUIN.
Providers who accept control totals (and associated conditions) will also be eligible to be considered for any discretionary capital allocations.
Community services will be invited to participate in a new local incentive scheme whereby they will be able to reinvest savings from acute excess bed day costs to expand community and intermediate care service.
CCG Quality Premium incentive funding will be contingent on performance on moderating demand for emergency care. Full details of the revised scheme will be published shortly
Implications for the Lifesciences Industry
This is a significant policy document and the impact will vary according to a Company’s commercial objectives. Contact us to discuss this in more detail. The following are likely to apply to all:
Value propositions (VP) should be aligned with the strategic direction being laid out as well as delivery of key performance indicators and the achievement of new incentives.
The push toward ICSs remains and will require local mapping of NHS plans and priorities, organisations and stakeholders to ensure the VP demonstrates value to the local system and is communicated effectively.
Medicines and devices will continue to be positioned as commodity goods and as an opportunity to generate cost savings unless the value to the NHS is clearly understood.
The NHS is keen to implement innovation that supports greater service efficiency but may require support to embed it.
For further information: https://www.england.nhs.uk/wp-content/uploads/2018/02/planning-guidance-18-19.pdf
