The contents of the Government's Operating Framework for the NHS for 2010/11, published on 16 December, are along the lines of what we were expecting and it does not set out any major change in priorities since the 2009/10 framework.
However initial NHS Confederation analysis showed:
- An expected 0% uplift in tariff and non tariff services. This assumes 3.5% efficiency saving from providers
- An increase in the proportion of tariff subject to CQUIN to 1.5%
- Some changes in structure of tariff and contracts
- A signal to move towards tariff as maximum price (we note this is a change in direction)
- PCTs will have rights to withhold a proportion of the contract payment up to 10% over time if providers do not met agreed patient satisfaction goals
- There is a need to clarify the £500m PCT and strategic health authority contribution to DH £2.3b savings. For providers this is already incorporated into the tariff as part of their efficiency savings
- Emergency activity will be based on 2008/09 activity levels – above this they will paid at 30% marginal tariff. Commissioner savings will be used to create a regional pool for system risk management and transformation
- 2% of committed spend by PCTs has to be non recurrent annually for the rest of spending review period. This will be aggregated across PCTs at regional level in 2010/11 but must be achieved by each PCT by 2013/14
- Despite speculation on the integration of health and social care budgets, there is no direct mention of this in the document. However there is a strong emphasis on working more effectively with local government
- There is a set timetable for plans for community services to be in place by March 2010 and for non-foundation trusts to have plans in place for achieving foundation status by March 2010 and to have achieved foundation trust status by 2013/14
- Management cost reductions in PCTs of 30% by 2013/14. There are no specific targets but costs will include PCT provider services, and most progress is to be made in the first two years (the extent of this will be at the SHA's discretion)
- Management consultancy services are to be used only when no other option is available
- A requirement to make a £1b surplus from PCTs and SHAs at end of 2010/11 to be indicatively deployed during 2011/12 to 2013/14.
NHS Confederation chief executive Steve Barnett said: “This year’s operating framework provides a further reminder of the scale of the efficiency savings the NHS needs to make if it is to survive the biggest financial challenge it has faced in a generation."
In his covering letter to NHS chief executives, chief executive of the NHS in England, David Nicholson, talked of:
- Quality - changes to the payment system for rewarding quality
- Sharing risk - the need to share risk across the system and re-balance risk between commissioners and providers
- System characteristics - seeking a reforming system where changes continue to be shaped locally by cooperation, competition and patient choice
- Integration - transforming patient pathways leading to integration of services and, in some cases, organisations.
Download the NHS Confederation briefing for members which covers the Pre Budget Report, the health secretary's From Good to Great vision, and the NHS Operating Framework for 2010/11.